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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

Authors

  • 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
Background

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.

Methods

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.

Results

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).

Conclusion

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.