Kidney Week

Abstract: PO0196

The Association of Metabolic Acidosis with AKI in Patients with CKD: A Retrospective Cohort Study in Two Cohorts

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Zhu, Antonia, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Antonia Zhu, MD

• Whitlock, Reid, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Reid Whitlock,

• Ferguson, Thomas W., University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Thomas W. Ferguson,

• Nourmohammadi, Mohammad, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Mohammad Nourmohammadi,

• Komenda, Paul, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Paul Komenda,

• Rigatto, Claudio, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Claudio Rigatto,

• Bohm, Clara, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Clara Bohm,

• Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States

Nancy L. Reaven,

• Funk, Susan E., Strategic Health Resources, La Canada, California, United States

Susan E. Funk,

• Tangri, Navdeep, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Navdeep Tangri,

Background

Metabolic acidosis in patients with chronic kidney disease (CKD) results from a loss of kidney function. It has been associated with more rapid CKD progression, all-cause mortality, and other adverse outcomes. Whether metabolic acidosis is associated with a higher risk of acute kidney injury (AKI) remains unknown.

Methods

We conducted a retrospective cohort study in 2 North American cohorts (US EMR cohort and Manitoba Claims cohort) using electronic health records and administrative data of patients with CKD Stages G3-G5. The primary exposure was metabolic acidosis (serum bicarbonate between 12 and <22 mEq/L), and the primary outcome of interest was the development of AKI (defined using ICD-9 and 10 codes at hospital admission or a laboratory-based definition based on KDIGO guidelines). We applied Cox proportional hazards regression models adjusting for common demographic and clinical characteristics.

Results

In both cohorts, metabolic acidosis was associated with AKI: HR 1.565 (95% CI 1.518 – 1.613) in the US EMR cohort and HR 1.652 (95% CI 1.578 – 1.729) in the Manitoba Claims cohort. The association was consistent when serum bicarbonate was treated as a continuous variable, and in multiple subgroup and sensitivity analyses including those adjusting for albuminuria.

Conclusion

Metabolic acidosis is associated with a higher risk of AKI in patients with CKD. AKI should be considered as a safety outcome in studies of treatments for patients with metabolic acidosis.

Funding

• Commercial Support –