{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:47Z","timestamp":1786480307639,"version":"build-2736575974"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Obesity is characterized by the accumulation of high serum levels of abnormal, negatively charged solutes and acid.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Findings were present among patients with normal kidney function, suggesting acid overproduction rather than acid retention.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity is associated with low serum bicarbonate, an indicator of metabolic acidosis and a CKD risk factor. To further characterize acid-base disturbance and subclinical metabolic acidosis in this population, we examined prospective associations of body mass index (BMI) with elevated anion gap and whether anion gap values in obesity associate with low bicarbonate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data from adult outpatients (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =94,448) in the Bronx, New York were collected from 2010 to 2018. Mixed effects models and Cox proportional hazards models were used to examine associations of BMI with elevated anion gap and anion gap metabolic acidosis and of baseline anion gap with incident low bicarbonate and anion gap metabolic acidosis. Anion gap was defined using traditional and albumin-corrected calculations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Greater BMI was associated with higher anion gap over time and with progressively greater risk of developing an elevated anion gap (hazard ratio [HR] for body mass index [BMI]\u226540 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      versus 18 to &lt;25 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 1.32; 95% confidence interval [95% CI], 1.23 to 1.42 for traditional and HR for BMI\u226540 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      versus 18 to &lt;25 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 1.74; 95% CI, 1.63 to 1.85 for corrected). Higher BMI was also associated with increased risk of developing anion gap metabolic acidosis (HR for BMI\u226540 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 1.53; 95% CI, 1.39 to 1.69). Among patients with obesity, higher anion gap was associated with increased risk of incident low bicarbonate (HR for fourth versus first quartile, 1.29; 95% CI, 1.23 to 1.44 for traditional and HR for fourth versus first quartile, 1.36; 95% CI, 1.26 to 1.48 for corrected) and higher risk of anion gap metabolic acidosis (HR for fourth versus first quartile, 1.78; 95% CI, 1.59 to 1.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Obesity is characterized by unmeasured anion accumulation and acid retention or overproduction. Modest elevations in anion gap among patients with obesity are associated with previously unrecognized anion gap metabolic acidosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0003562021","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T20:11:07Z","timestamp":1631218267000},"page":"1706-1715","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Obesity, Anion Accumulation, and Anion Gap Metabolic Acidosis: A Cohort Study"],"prefix":"10.34067","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3857-5005","authenticated-orcid":false,"given":"Douglas C.","family":"Lambert","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Northwell Health, Great Neck, New York"},{"name":"Section of Obesity Medicine, Northwell Health, Great Neck, New 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