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
- Streja, Elani, University of California Irvine Medical Center, Orange, California, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine Medical Center, Orange, California, United States
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