Abstract: PO0786
Metabolic Acidosis and the Risk of Progression to Diabetes in Patients with Prediabetes and CKD
Session Information
- Diabetic Kidney Disease: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States
- Funk, Susan E., Strategic Health Resources, La Canada, California, United States
- Lai, Julie C., Strategic Health Resources, La Canada, California, United States
- Mathur, Vandana S., MathurConsulting, Woodside, California, United States
- Tangri, Navdeep, Division of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
Background
Diabetes and metabolic acidosis are known risk factors for progression of CKD. Treatment of metabolic acidosis has been shown to reduce insulin resistance among patients with CKD and diabetes, but whether metabolic acidosis predicts progression from prediabetes to diabetes among patients with CKD is unknown.
Methods
Optum’s de-identified Integrated Claims-Clinical dataset of US patients (2007-2019) was queried for patients with non-dialysis CKD stages 3-5 with 2 consecutive serum bicarbonate of 12 to <22 mEq/L (metabolic acidosis) or 22 to <30 mEq/L (normal serum bicarbonate) with ≥1 year prior data and ≥2 years of post-index data or death within 2 years. Patients with prediabetes (HbA1c 5.7 to <6.5%, fasting plasma glucose 100 to <126 mg/dL, or 75 g oral glucose challenge 140–199 mg/dL) were followed for up to 11.5 years for incident diabetes identified through lab values, diagnosis, or prescriptions. Cox proportional hazards models were used to evaluate metabolic acidosis as a predictor of incident diabetes, adjusting for age, sex, race, low-income status, geo-coded education level, and baseline BMI, eGFR, metabolic syndrome and polycystic ovary syndrome. Death was also evaluated as a competing risk.
Results
7156/136,067 patients had evidence of prediabetes during the pre-index year. 47% (136/292) of patients with baseline metabolic acidosis and 46% (3143/6864) with normal serum bicarbonate developed diabetes during the outcome period (P=0.8). Patients with metabolic acidosis developed diabetes sooner on average compared with normal serum bicarbonate (544 vs 643 days); however, baseline metabolic acidosis was not a significant predictor of time to incident diabetes in adjusted analyses (HR 1.20, 95% CI:0.96-1.49). Metabolic syndrome (HR 1.26, 95% CI:1.08 1.46), Black race (HR 1.28 [1.11-1.47]), male sex (HR 1.11[1.01-1.21]), and higher BMI (HR 1.03 [1.02-1.03]) were associated with a higher risk of progression to diabetes. Higher baseline eGFR was associated with lower risk of progression to diabetes (HR 0.993 [0.988 0.997]).
Conclusion
In this longitudinal analysis of non-dialysis CKD stages 3-5 patients with prediabetes, metabolic acidosis was not associated with progression to diabetes.
Funding
- Commercial Support –