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Abstract: PO0468

Relationship Between Metabolic Acidosis and CKD Progression Is Evident Across US Racial and Ethnic Groups

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
  • Mathur, Vandana S., MathurConsulting, Woodside, California, United States
  • Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States
  • Funk, Susan E., Strategic Health Resources, La Canada, California, United States
  • Wesson, Donald E., Baylor Scott & White Health and Wellness Center, Dallas, Texas, United States

Metabolic acidosis is a known risk factor for CKD progression, but little is known about the impact of race and ethnicity on this relationship. We used a large electronic medical record (EMR) database of >100 million patients from all 50 states and insurance types to evaluate the relationship between metabolic acidosis and adverse renal outcomes and death by race and ethnicity.


De-identified electronic medical records (Optum® EHR), 2007–2019 were queried to identify patients with non-dialysis CKD Stages 3-5, ≥2 years of post-index data or death within 2 years, and grouped by baseline metabolic acidosis (12 to < 22 mEq/L) vs normal serum bicarbonate (22 to < 30 mEq/L). Patients (N = 136,067) were classified as Asian (N=1,328), Black (N=15,248), Hispanic (N=4,137), White (N=111,953) or Other (N=3,401). The primary endpoint was the composite outcome of death, kidney dialysis or transplant, or 40% decline in eGFR from baseline (DD40). Cox proportional hazards models examined the impact of serum bicarbonate on DD40 within each racial/ethnic group, adjusted for age, sex, eGFR, log albumin-to-creatinine ratio, diabetes, hypertension, heart failure, Charlson Comorbidity Score.


Overall, 47,032 patients (34.6%) experienced DD40 events within 2 years: Asian, 35%; Black, 44%; Hispanic, 48%; White, 32%; Other, 48%. Serum bicarbonate independently predicted DD40 in all racial/ethnic groups. Adjusted Hazard Ratios for DD40 per 1 mEq/L increase in serum bicarbonate (median 4.2 yrs, max 11.5 yrs follow-up) were as follows: Asian, 0.942 (CI: 0.917- 0.968); Black, 0.976 (CI: 0.969-0.983); Hispanic, 0.970 (CI: 0.956-0.984); White, 0.960 (CI: 0.957-0.963); P< 0.0001 for all groups.


In a large community-dwelling US population, serum bicarbonate was independently associated with adverse kidney outcomes and death in Asians, Blacks, Hispanics and Whites with CKD. Since race and ethnicity are associated with other sociodemographic factors that affect health, further exploration of the potential reasons for the observed range of hazard ratios across these groups is warranted.


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