Low serum bicarbonate in kidney transplant recipients is associated with an increased risk for graft failure, according to data presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

A study of a real-world population of 1722 renal transplant recipients who had a functioning graft at 1 year showed that each 1 mEq/L increase in serum bicarbonate over time was associated with a 10% reduction in graft failure risk in adjusted analyses, Vandana Mathur, MD, a nephrologist and president of MathurConsulting in Woodside, California, and colleagues reported in a poster presentation.

In addition, each 1 mEq/L increase in serum bicarbonate was associated with a 4% decreased risk for a composite of major cardiovascular (CV) events (MACE+) that included the first occurrence of myocardial infarction, stroke, new-onset heart failure (HF), a HF inpatient admission in patients with comorbid HF, or CV death.

Continue Reading

“Since metabolic acidosis is a risk factor for [chronic kidney disease] progression, we examined its role in predicting long-term graft loss in kidney transplant recipients in a large US community-based cohort,” Dr Mathur’s team explained.

They concluded, “The role of metabolic acidosis as a modifiable risk factor for chronic allograft nephropathy and MACE+ deserves further examination.”

The investigators analyzed data from the Optum EHR+Integrated dataset of US patients (2007-2019) with a kidney transplant preceded by 1 year or more of data and no graft loss during the first year.

The study cohort, which had a mean age of 51.1 years, consisted of 1034 male (60%) and 688 (40%) female patients. At baseline, patients had a mean estimated glomerular filtration rate of 63.4 mL/min/1.73 m2 and mean baseline serum bicarbonate level of 24.6 mEq/L. 

Disclosure: The authors were paid consultants to Tricida, Inc., which funded the study and is developing a medication to treat metabolic acidosis.


Mathur V, Reaven N, Funk S, Tangri N. Low serum bicarbonate is associated with graft failure in kidney transplant recipients. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10. Poster 276.