Kidney Week

Abstract: TH-PO1100

Association of Prescribed Sodium Bicarbonate Therapy with All-Cause Mortality in a National Cohort of Veterans with Incident CKD

Session Information

• CKD: Therapies, Innovations, and Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Takahashi, Rina, The Lundquist Institute, Torrance, California, United States

Rina Takahashi, MD, PhD

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

Csaba P. Kovesdy, MD, FASN

• Tran, Diana, The Lundquist Institute, Torrance, California, United States

Diana Tran, MPH

• Simon, Lewis, The Lundquist Institute, Torrance, California, United States

Lewis Simon, PhD, MPH

• Elali, Ibrahim, The Lundquist Institute, Torrance, California, United States

Ibrahim Elali, MD

• Shen, Jenny I., The Lundquist Institute, Torrance, California, United States

Jenny I. Shen, MD, MS, FASN

• Dukkipati, Ramanath B., The Lundquist Institute, Torrance, California, United States

Ramanath B. Dukkipati, MD

• Shah, Anuja P., The Lundquist Institute, Torrance, California, United States

Anuja P. Shah, MD

• Ismail, Adnan M., The Lundquist Institute, Torrance, California, United States

Adnan M. Ismail

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

Fridtjof Thomas, PhD

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

Keiichi Sumida, MD, PhD, MPH, FASN

• Rhee, Connie, VA Long Beach Healthcare System, Long Beach, California, United States

Connie Rhee, MD, MS

• Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

Background

Sodium bicarbonate is widely used in CKD to treat metabolic acidosis. While observational studies suggest possible survival benefits, meta-analyses of RCTs show no significant effect on mortality. Some trials also show no benefit in physical function or kidney outcomes. Concerns include sodium load, volume expansion, and metabolic alkalosis. The long-term effect on all-cause mortality remains unclear in large, nationally representative cohorts.

Methods

We conducted a retrospective cohort study using the national TRI-CKD database, including 50,577 United States veterans with incident CKD, defined by two outpatient eGFR values <60 mL/min/1.73 m² at least 90 days apart, both ≥25% below baseline, identified from October 1, 2004, to December 31, 2018. Follow-up continued until death or December 31, 2018. Bicarbonate users were defined as those prescribed after CKD onset. Cox proportional hazards models (Models 1–7) assessed all-cause mortality, adjusting for demographics, comorbidities, blood pressure, laboratory values (eGFR, UACR, serum albumin, bicarbonate, calcium), and ACE inhibitor/ARB use.

Results

Among 50,577 veterans with incident chronic kidney disease (mean age 65.0 years; 97% male), 11,901 received sodium bicarbonate. In unadjusted analysis, bicarbonate use was associated with higher mortality (HR 1.21; 95% CI 1.17–1.25). This association persisted in all adjusted models (HR range 1.09–1.59). In the fully adjusted model (Model 7), it remained significant (HR 1.16; 95% CI 1.11–1.22; see Figure).

Conclusion

Sodium bicarbonate use was associated with increased all-cause mortality despite extensive adjustment. These findings contrast with prior studies showing benefit or no significant association and highlight the need for careful patient selection and further clinical evaluation.

Funding

• Veterans Affairs Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025z24ady6t