ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO659

Metabolic Acidosis in Pediatric Participants with Glomerular Disease in the NEPTUNE and CureGN Cohorts

Session Information

  • Pediatric Nephrology - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Kilduff, Stella Rebecca, The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States
  • Troost, Jonathan P., Michigan State University, East Lansing, Michigan, United States
  • Eddy, Sean, Michigan State University, East Lansing, Michigan, United States
  • Brown, Denver D., Children's National Hospital, Washington, District of Columbia, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
  • Abramowitz, Matthew K., Albert Einstein College of Medicine, Bronx, New York, United States
  • Reidy, Kimberly J., The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States
  • Kaskel, Rick, The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States
Background

Metabolic acidosis (MA) has been associated with a more rapid decline of kidney function in cohorts of children with chronic kidney disease (CKD) and children with glomerular (vs. non-glomerular) CKD were more likely to have untreated acidosis. To date, no study has systematically examined MA in children with varying types of glomerular disease.

Methods

Children ages 1-17 y/o, enrolled in the NEPTUNE or CureGN studies with ≥1 serum bicarbonate and eGFR measurement were included. MA was defined as serum bicarbonate <22mEq/L, unresolved acidosis was acidosis at baseline that remained <22 mEq/L whereas resolved acidosis was baseline acidosis that improved to ≥22 mEq/L on repeated measures. The primary outcome of interest was eGFR slope (ml/min/1.73m2 per year) which was examined using an adjusted linear mixed-effects model.

Results

In the 786 participants eligible for study inclusion, the mean baseline serum bicarbonate was 24.8±3.15 meq/L. 12.2% (n=96) of the cohort were acidotic and only 1.4% (n=11) were receiving alkali therapy. In the adjusted longitudinal analysis, patients with unresolved acidosis had an eGFR slope difference per year of -12.4 ml/min/1.73m2 compared to those with resolved acidosis (95%CI: -17.5, -7.4) (Table 2).

Conclusion

Untreated MA is common in children with glomerular disease. Patients with unresolved MA had faster eGFR loss when compared to those with resolved acidosis from baseline. Future analyses will examine mechanistic pathways by which MA is proposed to contribute to disease progression through gene expression analysis.

Funding

  • NIDDK Support