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Abstract: PO1179

Bicarbonate Target in Treating Renal Acidosis: Is Higher Better?

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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

Author

  • Dwal, Ashraf, Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
Background

Metabolic acidosis is commonly seen in patients with CKD from a decrease in ammonium excretion which gets buffered by the extracellular bicarbonate, hence, low plasma carbon dioxide is a surrogate of acidosis. treatment of acidosis (usually sodium bicarbonate to decrease the progression of, maintain bone health, nutrition status, In clinical practice, we aim for plasma bicarbonate of ≥ 22 mmol/L, the upper limit target is unclear.

Methods

This was a single-center retrospective chart review of CKD patients with acidosis from 2010-2017. Inclusion criteria were adult patients receiving NaHco3 for CKD-associated acidosis with baseline estimated glomerular filtration rate (eGFR) ≥25 and < 60 ml/min/1.73 m2 when starting NaHco3. Patients with glomerulonephritis, kidney transplant, acute kidney injury (not back to at least 75% of (eGFR) baseline) were excluded. Four groups were identified for comparison based on mean serum Co2 (in mmol/L), from outpatient measures during 3 years follow-up, group A (< 22), group B (22 - < 24), group C (24 - <25), and Group D (≥ 25). Albumin, urine protein-creatinine ratio (UPCR), PTH, and eGFR were compared, p-values are calculated by a one-way ANOVA model.

Results

There were 383 patients with CKD-associated acidosis receiving NaHco3, 93 patients qualified for the study. Group A (n=21), group B (n=41), group C (n=13), and Group D (n=18). Racial demographics: 35=black (38%),57=white (61%), 1=Other. Females 49 (53%). Median age 69 years. Follow-up 3 years.
At baseline mean eGFR, UPCR, and albumin, and diuretics use and osteoporosis diagnosis in the four groups were similar (p = 0.46, 0.32, 0.15, 0.09, 0.36 respectively). Mean hemoglobin A1C in each group did not exceed 8.2. At 3 years of follow-up, changes in eGFR, UPCR, and osteoporosis status between the four groups were similar (p ≥ 0.14, ≥ 0.27, ≥ 0.19 respectively).Change of albumin was significantly worse in group A comparing to groups B, and C (p = 0.007, 0.049 respectively), and average PTH was significantly worse in group A comparing to group C (p = 0.045).

Conclusion

In our cohort, all groups of treated CKD-associated acidosis (B, C, and D) showed no statistical difference in CKD progression, the severity of parathyroidism, developing osteoporosis, or nutrition status assessed after 3years follow-up. Hence, higher Co2 targets don’t carry worse outcomes.