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Kidney Week

Abstract: FR-PO637

Outcomes of Correcting Metabolic Acidosis in CKD with Cirrhosis: A Retrospective Study

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Errabelli, Praveen K., University of Arkansas for medical Sciences, Little Rock, Arkansas, United States
  • Singh, Manisha, University of Arkansas For Medical Sciences, Little Rock, Arkansas, United States

Chronic Kidney Disease complications include metabolic acidosis. There is evidence of mortality benefit to correcting acidosis to bicarbonate levels of around 22 meq/L. Conversely, in chronic liver disease, respiratory alkalosis is the most common acid-base disorder,which manifests as low serum bicarbonate on labs.Physiologically, it appears that correcting metabolic acidosis to a reasonable level may provide benefit to CKD with cirrhosis,however most practices do not get a venous or arterial blood gases to first identify the cause of low serum bicarbonate. The impact of identifying and managing metabolic acidosis in patient with cirrhosis has not been studied well. Correcting acidosis commonly requires using sodium containing salts,which can lead to sodium overload resulting in increased need for paracentesis procedures. Our hypothesis is that adding oral sodium bicarbonate (NaHco3) targeting bicarbonate 22 meq/L would lead to increased ascites and more frequent paracentesis so we should target lower bicarbonate levels in cirrhosis.


We conducted a single center retrospective chart review of all patients with CKD and Cirrhosis, managed at University of Arkansas for Medical Sciences, over a period of 5 years to study incidence of paracentesis correlated with oral bicarbonate therapy.


Out of 366 patients with the diagnosis of CKD and cirrhosis, 200 patients did not get paracentesis.Out of these 31(15.5%) were on oral bicarbonate.166 patients recieved paracentesis out of which 41 (24.7%) were on bicarbonate. However,this difference was not statistically significant (P value 0.0383).


KDIGO guidelines recomend correcting metabolic acidosis with oral bicarbonate supplementation to prevent CKD progression targeting serum bicarbonate of about 22 meq/L. However, it is not clear if we can extend this to the population with cirrhosis and CKD. Purpose of our study is to address this question and to study the effects of bicarbonate supplementation with regard to its effect on incidence of paracentesis procedures that can lead to increased complications for these patients. Our retrospective data suggests that patients on oral NaHco3 require frequent paracentesis, but has not met statistical significance. We plan a prospective randomized control study to address this question better.