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