{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T12:08:01Z","timestamp":1785154081634,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T00:00:00Z","timestamp":1647734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Background<\/jats:bold>: Hyperchloremic metabolic acidosis (HCMA) from renal tubular acidosis (RTA) is common in kidney transplant (KT) recipients. Calcineurin inhibitors (CNIs) are a potential cause of RTA, and whether HCMA is a determinant of poor graft prognosis is controversial.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: The subjects were living\u2010donor KT recipients (LDKTRs,<jats:italic>n<\/jats:italic>\u00a0=\u00a047) and matched donors (<jats:italic>n<\/jats:italic>\u00a0=\u00a043). All cases of rejection, extrarenal causes, and respiratory disorders were excluded. HCMA was defined as having a [Na+]\u2013[Cl<jats:sup>\u2212<\/jats:sup>] value of \u226434 or starting alkalization. We determined the potential causes of HCMA in LDKTRs at 3 months (m) and 1 year (y) post\u2010KT. We examined renal hemodynamic parameters in 26 LDKTRs at 1 y post\u2010KT: namely, glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF; GFR\/RPF) and pre\u2010\/post\u2010glomerular vascular resistance (pre\u2010\/postVR).<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: The HCMA incidence in the 3\u2010m post\u2010KT LDKTR group was higher than that of the donors (51.0%\u00a0vs. 6.9%,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001, adjusted odds ratio: 6.7\u201315.7). Among adjusted factors, the most dominant HCMA contributor was low hemoglobin concentration (Hb\u00a0\u2264\u00a012\u00a0g\/dl). Compared to non\u2010HCMA cases, HCMA patients had low FF and low post\u2010VR (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.008, 0.003, respectively) suggesting increased intrarenal post\u2010glomerular blood flow. The high pathological score of alternative arteriolar hyalinosis (aah) \u22652 was a significant HCMA risk. The tacrolimus trough level was not high in HCMA but was significantly high in HCMA in the low post\u2010VR setting (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.002).<\/jats:p><jats:p><jats:bold>Conclusion<\/jats:bold>: Among LDKTRs, low hemoglobin level is an important contributor to the manifestation of HCMA in the induction period, and increased intrarenal post\u2010glomerular blood flow is a key condition for the development of CNI\u2010induced RTA.<\/jats:p>","DOI":"10.1111\/ctr.14648","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T10:00:38Z","timestamp":1647424838000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Increased intrarenal post\u2010glomerular blood flow is a key condition for the development of calcineurin inhibitor\u2010induced renal tubular acidosis in kidney transplant recipients"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8613-6499","authenticated-orcid":false,"given":"Shuzo","family":"Kaneko","sequence":"first","affiliation":[{"name":"Department of Nephrology Faculty of Medicine University of Tsukuba Ibaraki Japan"},{"name":"Department of Nephrology Itabashi Chuo Medical Center Itabashi Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joichi","family":"Usui","sequence":"additional","affiliation":[{"name":"Department of Nephrology Faculty of Medicine University of Tsukuba Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1089-0644","authenticated-orcid":false,"given":"Kazuhiro","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation University of Tsukuba Tsukuba Ibaraki 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