Kidney Week

Abstract: TH-PO1071

Association of Prescribed Bicarbonate Therapy with Incident Kidney Failure in Veterans with CKD

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | 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

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

Diana Tran, MPH

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

Rina Takahashi

• 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

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• 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, University of California Los Angeles, Los Angeles, 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

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

Csaba P. Kovesdy, MD, FASN

Background

Treatment of metabolic acidosis may delay the renal function decline in patients with chronic kidney disease (CKD), but the effects of bicarbonate on CKD progression to end-stage renal disease (ESRD) in unselected populations with all stages of CKD remain unclear. We examined the association of bicarbonate use with incident ESRD in a large national cohort of United States (US) Veterans.

Methods

In a cohort of 50,540 patients with incident CKD (eGFR <60 mL/min/1.73m²), we examined the association of de novo bicarbonate prescription with incident ESRD (defined as initiation of renal replacement therapy) during the 14-year follow-up using Cox proportional hazard models adjusted for demographics, major comorbidities, baseline eGFR, urine albumin-creatinine ratio (UACR), and use of renin angiotensin-system inhibitors. Additionally, propensity score (PS) overlap weighting, inverse probability of treatment weighting (IPTW), and PS matching were used to reduce confounding.

Results

We identified 11,896 incident bicarbonate users. Overall mean age was 65, with 3.0% female, 15.3% Black, and 5.5% Hispanic, baseline serum bicarbonate of 24.2±4.4 (users 20.2±3.7, non-users 26.1±3.4) mEq/L, and eGFR of 35.5±11 mL/min/1.73m². Bicarbonate users were more likely to be male, Black, current smokers, had higher frequencies of diabetes and liver disease, and lower eGFR compared to non-users. Bicarbonate use (vs. non-use) was associated with a higher risk of incident ESRD in the fully adjusted model (HR: 1.48, 95% CI: 1.38-1.60), PS overlap weighting (1.41, 1.29-1.55), IPTW (1.24, 1.19-1.29), and PS matching (1.72, 1.61-1.85).

Conclusion

In this large national cohort of US Veterans with long follow-up, bicarbonate use was associated with a higher risk of incident ESRD. Further studies are needed to test the effects of bicarbonate replacement on CKD progression.

Funding

• Veterans Affairs Support