The risk of metabolic acidosis in diabetic patients with different severity of chronic hepatitis B-related cirrhosis and renal impairment
Refereed conference paper presented and published in conference proceedings


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AbstractBackground: We examined the interaction between severity of renal and liver impairment on the risk of metabolic acidosis in diabetic patients with chronic hepatitis B (CHB)-related cirrhosis.

Methods: This is a retrospective cohort study on diabetic patients with CHB-related cirrhosis between January 2000 and December 2017 using Clinical Data Analysis and Reporting System, which is a territory-wide electronic healthcare database that captures in-patient and out-patient data of all public hospitals and clinics and represents 90% of the 7.3 million Hong Kong population. Metabolic acidosis was defined by blood pH≤7.35 with arterial bicarbonate ≤18 mmol/L or venous bicarbonate ≤21 mmol/L or lactate >5 mmol/L, and/or diagnosis codes. Renal and liver function were modelled by time-dependent estimated glomerular filtration rate (eGFR) category and Child-Pugh class. Time-dependent medication uses and comorbidities were included in Fine-Gray model adjusted for competing for death. We excluded patients with eGFR <30 mL/min/1.73 m2 or renal replacement therapy at baseline.

Results: Of 4,431 diabetic patients with CHB-related cirrhosis, 3,216 (72.6%) were male; the mean age (SD) was 60.8 (10.8) years; 1,590 (35.9%), 2,029 (45.8%), 544 (12.3%) and 268 (6.0%) had baseline eGFR ≥90, 60–89, 45–59 and 30–44 mL/min/1.73 m2; 3,217 (72.6%), 1,028 (23.2%) and 186 (4.2%) were in Child-Pugh class A, B and C at baseline (figure 1). At a median (interquartile range) follow-up of 5.3 (2.0–9.7) years, 1,060 (23.9%) patients developed metabolic acidosis. In Child-Pugh class A, the risk of metabolic acidosis elevated in eGFR <45 mL/min/1.73 m2 (adjusted subdistribution hazard ratio [SHR] 4.02, 95% CI 2.42–6.68, P<0.001). The risk of metabolic acidosis increased in Child-Pugh class B and C at any eGFR levels (adjusted SHR ranged from 4.24 to 91.66), particularly in Child-Pugh class C with eGFR <30 mL/min/1.73 m2 (adjusted SHR 91.66, 95% CI 60.69–138.44, P<0.001).

Conclusions: The risk of metabolic acidosis increases with renal and liver impairment in diabetic patients with CHB-related cirrhosis.
All Author(s) ListTerry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Henry Lik-Yuen Chan, Yee-Kit Tse, Grace Lai-Hung Wong
Name of ConferenceInternational Digestive Disease Forum (IDDF) 2019
Start Date of Conference08/06/2019
End Date of Conference09/06/2019
Place of ConferenceHong Kong Convention and Exhibition Centre
Country/Region of ConferenceHong Kong
Proceedings TitleGut
Year2019
Month6
Volume Number68
Issue NumberSuppl 1
PublisherBritish Society of Gastroenterology and BMJ
PagesA144 - A145
ISSN0017-5749
eISSN1468-3288
LanguagesEnglish-United Kingdom

Last updated on 2020-31-05 at 02:30