WASHINGTON—Metabolic acidosis is underdiagnosed and undertreated in patients with chronic kidney disease (CKD) in the United States, according to new study findings presented at the American Society of Nephrology’s Kidney Week 2019 meeting.

Using integrated records from claims, prescription, and laboratory sources (Symphony Health Solutions), Navdeep Tangri, MD, PhD, of the University of Manitoba in Canada, identified 86,782 US adults with CKD and chronic metabolic acidosis based on serial measurements of estimated glomerular filtration rate (eGFR) and serum bicarbonate. Of these, just 21% had a diagnostic code for metabolic acidosis. Older age and higher eGFR were associated with a lower likelihood of diagnosis. A nephrology visit, health insurance, and having comorbid conditions were associated with a greater likelihood of diagnosis. Furthermore, only 15% of patients received oral alkali therapy, and only 36% of these patients remained on therapy at 2 years. Discontinuation rates for oral alkali therapy were high within the first 180 days of use.

“Metabolic acidosis is not just a complication. It’s a cause of progressive CKD,” Dr Tangri emphasized in an interview with Renal & Urology News. “This study finds that it’s both underrecognized and undertreated. Nephrologists should check serum bicarbonate every time they see a patient with CKD stage 3 to 5. If it has fallen to less than 22 mEq, treat the acidosis with diet and other therapies. Fruits and vegetables are underutilized.

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“The most common treatment, sodium bicarbonate, is often taken 6 to 12 pills per day, but it can cause gastrointestinal upset, salt retention related to hypertension, fluid retention, and edema.

“Novel, alternative therapies are under investigation that may be better tolerated. Veverimer, for example, has been the subject of several papers and is in development.”

The study was funded by Tricida, the makers of veverimer. Dr Tangri serves as a scientific advisor.


Tangri N. Metabolic acidosis is underdiagnosed and undertreated in patients with CKD. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington DC. Poster FR-PO632.