Abstract: TH-PO0390
Assessment and Treatment of Metabolic Acidosis in CKD: Registry-Based Study
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Tanaka, Mai, Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Hosojima, Michihiro, Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Kabasawa, Hideyuki, Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Goto, Shin, Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Kishi, Seiji, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Itano, Seiji, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Nagasu, Hajime, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Kashihara, Naoki, Kawasaki Geriatric Medical Center, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Yamamoto, Suguru, Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Background
Metabolic acidosis (MA) is common in patients with chronic kidney disease (CKD) and is associated with adverse effects. Despite guidelines recommending treatment, reports from Western countries have suggested that MA is often underdiagnosed and undertreated. Meanwhile, the prevalence and management patterns of MA are different in Asian countries such as Japan, possibly because the dietary acid load is different from that in a typical Western diet, but the details remain unclear. This study aims to assess the serum bicarbonate measurement rate and the prevalence, diagnosis, and treatment rates of MA in Asian CKD patients using the Japan Chronic Kidney Disease Database (J-CKD-DB-Ex).
Methods
The J-CKD-DB-Ex, a nationwide electronic medical record database, collects data from 21 university hospitals across Japan. Patients included were aged 18 years or older with proteinuria of 1+ or higher (dipstick test) or eGFR below 60 mL/min/1.73 m2. Patients with eGFR below 15 mL/min/1.73 m2 were excluded. We evaluated the rate of serum bicarbonate measurement, the prevalence of MA (serum bicarbonate <22 mEq/L), and the diagnosis and treatment rates, based on ICD-10 codes and sodium bicarbonate prescriptions.
Results
Between 2014 and 2021, the annual measurement rate of serum bicarbonate was consistently below 10%, ranging from 7.8% to 9.0%. Among 22,309 patients who had at least one serum bicarbonate measurement during this period, the overall prevalence of MA was 44.2%. Stratified by CKD stage, the prevalence was 31.8% in G3a, 46.4% in G3b, and 65.8% in G4. In patients with MA, the diagnosis and treatment rates were 8.6% and 7.5%, respectively. By CKD stage, the diagnosis rates were 4.8%, 6.9%, and 13.7% and treatment rates were 3.6%, 5.2%, and 13.4% in G3a, G3b, and G4, respectively.
Conclusion
This study demonstrated that MA may be inadequately assessed and treated in Japanese patients with CKD. This highlights the need for improved clinical management, including pharmacological and dietary interventions. However, further evidence and discussion are needed regarding intervention thresholds, treatment goals, and optimal treatment selection.