WASHINGTON—Metabolic acidosis increases the risk for major adverse cardiovascular (CV) events in patients with predialysis chronic kidney disease, investigators reported at the American Society of Nephrology’s Kidney Week 2019 meeting.

Using the Optum database, Navdeep Tangri, MD, PhD, of the University of Manitoba in Canada, and colleagues identified the electronic medical records of 51,558 stage 3 to 5 CKD patients. Patients with metabolic acidosis (serum bicarbonate 12 to less than 22 mEq/L) had significantly higher incidences of adverse CV events at 2 years than those with normal serum bicarbonate (22 to 29 mEq/L). Heart failure occurred in 29.8% vs 22.8%, stroke in 19.5% vs 17.2%, and acute myocardial infarction in 17.2% vs 12.3%, respectively.

During 10 years of follow-up, having low serum bicarbonate was independently associated with adverse CV outcomes, after adjusting for patient age, sex, race, estimated glomerular filtration rate, diabetes, hypertension, coronary artery disease, peripheral vascular disease, hemoglobin level, and serum albumin.

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Each 1 mEq/L increase in serum bicarbonate was significantly and independently with a 2.4% decrease in new onset heart failure, a 2.1% decrease in stroke, and a 3.6% decrease in myocardial infarction.

Hospital admissions overall and for the top 3 causes of hospitalization—sepsis, renal failure, and heart failure—were more common among patients with metabolic acidosis than those with normal serum bicarbonate.

“Practicing nephrologists should know that metabolic acidosis may be a risk factor for conditions other than renal outcomes,” co-author Nancy L. Reaven, MA, of Strategic Health Resources in La Canada, California, told Renal & Urology News. “They need to monitor serum bicarbonate early and often, paying special attention to cardiovascular risk factors.”

The study was funded by Tricida Inc.


Reaven NL, Funk SE, Mathur VS, Tangri N. Association of metabolic acidosis with adverse cardiovascular outcomes in patients with CKD. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington DC. Poster TH-PO693.