Metabolic Acidosis Increases Risk of Adverse Renal Outcomes, Death

In a large study of patients with chronic kidney disease, metabolic acidosis independently increased the risk of progressing to end-stage renal disease and death. Metabolic acidosis in patients with chronic kidney disease (CKD) is independently associated with an increased risk of renal function decline and death, data presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston suggest.

“Serum bicarbonate, a readily available laboratory test, was found to be an important and independent predictor of risk of poor kidney outcomes and death, and conversely, a higher bicarbonate level predicted improved outcomes,” said lead investigator Vandana Mathur, MD, a nephrologist and president of MathurConsulting of Woodside, California.

The study included 51,588 patients with non-dialysis CKD followed longitudinally, of whom 40,833 were aged 65 years or older and 10,725 were younger than 65 years. The objective was to quantify the influence of metabolic acidosis on adverse kidney outcomes; the primary outcome was a composite of death, chronic dialysis, kidney transplant, or 40% or greater decline in estimated glomerular filtration rate.

Each 1 mEq/L increment in serum bicarbonate was associated with a 8% and 5% decreased risk of the composite outcome over 2 years among patients aged 65 years or older and those younger than 65 years, respectively, Dr Mathur and colleagues reported in a poster presentation. The findings persisted after adjusting for sex, race, baseline age, hypertension, diabetes, heart failure, Charlson Comorbidity Index, and other variables.

Among patients aged 65 years or older, the 2-year rates of progression to chronic dialysis and death were significantly higher among the 12,172 patients with metabolic acidosis than the 28,661 patients with normal serum bicarbonate levels (13% vs 4% and 35% vs 11%, respectively).

Among patients younger than 65 years, the 2-year rates of progression to chronic dialysis and death also were significantly higher among the 5178 patients with metabolic acidosis than the 5547 patients with normal serum bicarbonate levels (29% vs 11% and 21% vs 7%, respectively).

The investigators defined metabolic acidosis as 2 serum bicarbonate values of 12 mEq/L or higher but less than 22 mEq/L. The reference range was 22 to 29 mEq/L

Read more of Renal & Urology News’ coverage of NKF’s 2019 Spring Clinical Meetings by visiting the conference page .

Reference

Reaven NL, Funk SE, Tangri N, Mathur V. Adverse clinical outcomes in patients with chronic kidney disease and metabolic acidosis: A longitudinal analysis from electronic medical records of >50,000 patients. Poster presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, May 8-12. Poster 296.

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