Kidney Week

Abstract: TH-PO852

Association of Bicarbonate Therapy With Incident CKD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Wang, Hanwen, University of California Los Angeles, Los Angeles, California, United States

Hanwen Wang,

• Streja, Elani, University of California Irvine Medical Center, Orange, California, United States

Elani Streja,

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida,

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, University of California Irvine Medical Center, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

Sodium bicarbonate is used to treat metabolic acidosis and may delay deterioration of kidney function in patients with chronic kidney disease (CKD), but its effects on end-stage kidney disease (ESKD), incident CKD, and death in patients with normal kidney function are unclear.

Methods

We examined a national cohort of 238,313 US veterans with normal baseline kidney function (eGFR ≥60 ml/min/1.73m² and UACR <30 mg/g). We examined the association of de novo prescription of bicarbonate with ESKD, incident CKD (defined as two eGFR values <60 ml/min/1.73m² at least 90 days apart), and all-cause mortality, over a follow-up of up to 14 years. Associations were examined in Cox models and competing risk analyses adjusted for demographics, major comorbidities, baseline eGFR, and serum bicarbonate level. We also analyzed associations in a propensity score (PS)-matched cohort.

Results

We identified 2,992 Veterans who were incident bicarbonate users. Overall, patients had a mean age of 58 ± 12 years, with 7% female, 18% Black, and 7.7% Hispanic. Bicarbonate users (vs non-users) had a 1.7-fold higher risk of ESKD (SHR: 1.71, 95%CI: 0.69, 4.21), a 2-fold higher risk of incident CKD (SHR: 2.04, 95%CI: 1.87, 2.23), and a 3.3-fold higher risk of death (HR: 3.33, 95%CI: 3.15, 3.51) (Table). Results were consistent in a PS-matched cohort.

Conclusion

In this cohort of veterans with normal baseline kidney function, sodium bicarbonate use was associated with higher risks of ESKD, incident CKD, and mortality. Additional research is needed to determine if bicarbonate treatment is a surrogate of disease conditions associated with a higher risk of CKD, or if it causes deleterious outcomes directly.

Funding

• NIDDK Support