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Kidney Week

Abstract: TH-OR124

Metabolic Acidosis Is a Risk Factor for Ischemic Cardiovascular Events in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • Djamali, Arjang, School of Medicine and Public Health, Madison, Wisconsin, United States
  • Wilson, Nancy A., University of Wisconsin, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States

Metabolic acidosis is associated with disease progression and death in CKD. However, there is limited information on whether metabolic acidosis is a risk factor for poor outcomes after kidney transplantation.


We examined the association between mean total serum bicarbonate levels(TCO2) at one-year and the incidence of all-cause mortality, de novoischemic, arrhythmic, or heart failure events in 2018 kidney transplant recipients.


The prevalence of metabolic acidosis defined as TCO2 <24 mEq/L, was 16.9% (n=341). There were 593 deaths and 363 recipients with a CVE over a median follow-up of 3.75 years. CVE included 221 ischemic, 63 arrhythmic, and 178 heart failure events. TCO2 < 22 mEq/L was associated with increased risk of CVE (adjusted HR 2.22; 95%CI 1.41, 3.48). This association was primarily due to ischemic CVE (aHR 2.51; 95%CI 1.43, 4.40). For every 1 mEq/L TCO2 below 24 mEq/L, the risk of all CVE and ischemic events was 18% and 17% higher, respectively (aHR for all CVE 0.82; 95% CI 0.72, 0.94, and aHR for ischemic CVE 0.83; 95% CI 0.71, 0.98). Notably, TCO2 < 22 mEq/L was an independent risk factor for all-cause mortality (aHR 1.85; 95% CI 1.28, 2.68). For every 1 mEq/L TCO2 below 24 mEq/L, the risk of death was 17% higher (aHR 0.83; 95%CI 074, 0.92).


In summary, metabolic acidosis is a risk factor for ischemic CVE and all-cause mortality in kidney transplant recipients. Clinical trials are needed to determine the safety and efficacy of alkali therapy for CVE after renal transplantation.