Abstract: SA-PO836
Metabolic Acidosis Is Associated with Failure to Thrive and Fractures and Falls in Patients with CKD
Session Information
- Health Maintenance, Nutrition, Metabolism - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States
- Funk, Susan E., Strategic Health Resources, La Canada, California, United States
- Mathur, Vandana S., Mathur Consulting, Woodside, California, United States
- Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
Background
Metabolic acidosis causes muscle-wasting and bone loss in experimental animal and human studies. However, its association with clinical outcomes in epidemiological studies is unknown. Here we assess the role of metabolic acidosis as an independent predictor of adverse muscle, bone and functional outcomes in patients with non-dialysis CKD.
Methods
De-identified electronic medical records (Optum® EMR), 2007–2017 were queried to identify non-dialysis CKD patients with ≥2 consistent serum bicarbonate test values 28–365 days apart, ≥3 eGFR values >10 and <60 mL/min/1.73m2 and ≥2 years of post-index data or until death. Patients were followed for 2 years for adverse outcomes using ICD codes: failure to thrive (muscle/functional outcome); composite of hip, spine, pathological fractures or falls (bone outcome). Metabolic acidosis and normal serum bicarbonate groups were defined by two serum bicarbonate values between 12 and <22 mEq/L and 22-29 mEq/L, respectively. Logistic regression was used to examine serum bicarbonate as an independent predictor of 2-year outcomes and possible demographic and comorbidity confounding factors.
Results
51,558 patients qualified for this longitudinal observational study. The incidence of adverse outcomes was significantly higher in patients with metabolic acidosis during the 2-year follow-up compared to patients with normal serum bicarbonate: muscle outcomes: 6.5% vs. 1.9%, p<0.0001; bone outcomes: 17.3% vs. 11.6%, p<0.0001, respectively. Serum bicarbonate was a significant predictor of both types of outcomes; odds ratios for failure to thrive, 0.883, CI: 0.869-0.898, and for fracture/fall, 0.948; CI: 0.939-0.956, independent of age, sex, race, eGFR, diabetes, hypertension, heart failure, coronary artery disease, peripheral vascular disease, hemoglobin and serum albumin. Each 1 mEq/L increase in serum bicarbonate was associated with a 12% decrease in failure to thrive and a 5% decrease in fracture/fall risk.
Conclusion
In this analysis of > 51,000 non-dialysis CKD patients followed for 2 years, metabolic acidosis was independently associated with increased incidence of failure to thrive and the composite endpoint of fractures (hip, spine, or pathological) and falls.
Funding
- Commercial Support – Tricida, Inc.