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Kidney Week

Abstract: FR-PO632

Metabolic Acidosis Is Underdiagnosed and Undertreated in Patients with CKD

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada

Metabolic acidosis is a common complication of chronic kidney disease (CKD) and is associated with adverse effects on physical function, accelerated CKD progression and increased mortality. Although chronic metabolic acidosis can be easily identified using routinely collected laboratory tests, there is limited data on its recognition and treatment.


We integrated laboratory data from 36 million US adults with de-identified longitudinal claims and prescription data from 280 million de-identified individuals included in the Symphony Health Solutions IDV® (Integrated Dataverse). Patients who met stringent laboratory criteria indicative of CKD and chronic metabolic acidosis were included: ≥2 eGFRs <60 ml/min/1.73m2 with no intervening eGFR ≥60 ml/min/1.73m2; ≥2 serum bicarbonates ≥12 to <22 mEq with no intervening bicarbonate <12 or ≥22 mEq/L; qualifying values ≥28 days apart. No patients with a diagnosis of acute kidney injury (AKI) within 28 days prior to either qualifying bicarbonate value were included. A physician diagnosis of metabolic acidosis was based on administrative claims, and treatment of metabolic acidosis was defined as a prescription for oral alkali therapy.


Approximately 2.4 million individuals met laboratory criteria for CKD, 118,620 of those also met laboratory criteria for metabolic acidosis. Claims and prescription data were available for 86,782 individuals with both CKD and chronic metabolic acidosis. In this population, a diagnostic code for metabolic acidosis was present in only 21% of patients (N=19,038). The overall frequency of oral alkali therapy use was 15% (N=13,272) ranging from 10% in those without a diagnostic code for acidosis to 34% in those with the appropriate diagnostic code.


Metabolic acidosis is underdiagnosed and undertreated in US adults with CKD. Disease specific educational efforts as well as development of novel treatments is needed to improve outcomes for this important complication.


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