The following article features coverage from the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings. Click here to read more of Renal and Urology News’ conference coverage.

Metabolic acidosis (MA) is common among patients who have both chronic kidney disease (CKD) and hyperkalemia, and its prevalence increases with higher potassium levels, investigators reported at the live virtual 2020 National Kidney Foundation Spring Clinical Meetings.

They estimated that about one fourth of patients with CKD and hyperkalemia have MA when hyperkalemia is defined as a potassium level above 5.0 mEq/L and MA is defined as a bicarbonate level below 22 mEq/L.

Using electronic medical records from the Research Action for Health Network (REACHnet), Erin Cook, MPH, ScD, of the Analysis Group in Boston and colleagues estimated the annual prevalence of MA in patients with CKD stage 3 to 5 and hyperkalemia from 2014 to 2017. The researchers used 2 definitions of MA—bicarbonate levels less than 22 and less than 18 mEq/L—and 2 definitions of hyperkalemia—potassium levels greater than 5.0 and greater than 5.5 mEq/L.

During the study period, the estimated prevalence of MA (serum bicarbonate level less than 22 mEq/L) ranged from 24.5% to 29.4% for patients with potassium levels higher than 5.0 mEq/L and 33.1% to 39.1% among those with potassium levels above 5.5 mEq/L. The prevalence of MA (serum bicarbonate level less than 18 mEq/L) ranged from 5.5% to 6.9% among patients with potassium levels above 5.0 mEq/L and 9.1% to 10.8% among those with potassium levels above 5.5 mEq/L.

“Since metabolic acidosis can be caused by hyperkalemia and vice versa, it is important to consider metabolic acidosis when managing hyperkalemia in patients with CKD,” the investigators wrote in a poster presentation.

In addition, they noted that “treatments that can address both metabolic acidosis and hyperkalemia would be beneficial for patients given their common occurrence in patients with CKD.”

The study population included patients with CKD and hyperkalemia who had a bicarbonate lab value available each year from 2014 to 2017. For 2014, 2015, 2016, and 2017, the sample sizes were 2534, 3477, 4253, 4506 patients with potassium levels above 5.0 mEq/L, respectively, and 698, 936, 1109, and 1195 patients with potassium levels above 5.5 mEq/L, respectively.

The authors acknowledge that a limitation of the study was that only patient encounters within the healthcare systems that were part of REACHnet were available, so the prevalence estimates could be lower than the true prevalence.

Read more of our coverage of the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings by visiting the conference page.

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Reference

Cook C, Davis J, Israni R, et al. Prevalence of metabolic acidosis among patients with CKD and hyperkalemia. Data presented at the live virtual 2020 National Kidney Foundation Spring Clinical Meetings held March 25 to 29. Poster 316.https://casehippo.com/apps/symposium/national-kidney-foundation-2020-spring-clinical-meetings/event/gallery/abstracts?abstractId=930