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Kidney Week

Abstract: PO1481

Metabolic Acidosis in CKD: Time for a New Approach?

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical


  • Robinson, Jennifer, Spherix Global Insights, Exton, Pennsylvania, United States
  • Hurtado, Tucker Bittel, Spherix Global Insights, Exton, Pennsylvania, United States

Group or Team Name

  • Spherix Global Insights Advanced Analytics Group

Metabolic acidosis in chronic kidney disease (CKD) is relatively common and increases as renal function declines. More recently, metabolic acidosis has been identified as a key risk factor for the progression of CKD in addition to being linked to increased risk of renal osteodystrophy and muscle wasting. Presently, there are no FDA indicated therapies for the treatment of chronic metabolic acidosis, though sodium bicarbonate is commonly used to try to maintain serum bicarbonate levels in the normal range (22 – 29mEq/L). We sought to understand how prevalent metabolic acidosis is in a real world setting.


Patient level data was collected online via a HIPAA-compliant form in November 2019 as part of an independent chart audit. A total of 1,008 patient records were submitted by 201 nephrologists. Records were selected based on the most recently seen non-dialysis patients in the outpatient setting with an eGFR<60ml/min/1.73m2.


At the time of first referral to a nephrologist, 92% of patients had a bicarbonate measure in the chart and 29% initially presented with a level <22mEq/L. At the most recent visit, 14% of the CKD Stage 3 patients, 37% of the CKD Stage 4 patients, and 57% of the CKD Stage 5 (non-dialysis) patients had low levels of serum bicarbonate. Among the patients being treated with sodium bicarbonate, 58% were below 22mEq/L, suggesting that treatment may not be entirely effective.
The co-morbidity burden for CKD patients is extremely high. Many patients with serum bicarbonate levels below target have hypertension (80%, 28% classified as uncontrolled), diabetes (46%), heart failure (13%), and coronary artery disease (24%) – conditions that could be aggravated by sodium-containing medications. Furthermore, among those with low serum bicarbonate levels, 33% were notable for edema at the most recent visit. Indeed, overall the rate of edema across all stages of CKD was 22%, but this symptom was significantly higher among patients on sodium bicarbonate.


Metabolic acidosis is highly prevalent in CKD patients. Additionally, the vast majority of patients with metabolic acidosis have co-morbidities that make them not ideally suited for sodium-containing products. New agents that can address metabolic acidosis without a sodium load may provide a better options for these patients.