Bicarbonate therapy is associated with an increased risk for incident chronic kidney disease (CKD) and death among US veterans with normal baseline kidney function, investigators reported at the American Society of Nephrology’s Kidney Week 2022 conference in Orlando, Florida.

The finding is from a study of a national cohort of 238,313 US veterans (mean age 58 years) with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher and urinary albumin to creatinine ratio less than 30 mg/g at baseline. Of these, 2992 were incident bicarbonate users. For the overall cohort, bicarbonate therapy was significantly associated with a 2.0-fold increased risk for incident CKD and 3.3-fold increased risk for death in adjusted analyses, Hanwen Wang, MD, of Tibor Rubin VA Medical Center in Long Beach, California, and colleagues reported. In a propensity score (PS) matched cohort of 5968 patients, bicarbonate therapy was significantly associated with a 2.8-fold increased risk for incident CKD and 2.3-fold increased risk for death.

In both the overall cohort and the PS matched cohort, patients who received bicarbonate therapy had a nonsignificant 1.7-fold and 6.8-fold increased risk for end-stage kidney disease.

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Bicarbonate users were more likely than non-users to be Black, male, and current smokers, and to have a higher burden of comorbidities such as chronic pulmonary disease, peptic ulcers, dementia, liver diseases, cancers, and cardiovascular problems. The cohort had up to 14 years of follow-up.


Wang H, Streja E, Sumida K, et al. Association of bicarbonate therapy with incident chronic kidney disease. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract TH-PO852.