Increasing serum bicarbonate levels in patients with chronic kidney disease (CKD) are associated with a reduced risk for disease progression, new study findings suggest.

Navdeep Tangri, MD, PhD, of the University of Manitoba in Winnipeg, Manitoba, Canada, and colleagues conducted a retrospective observational study of 24,384 patients with CKD stages 3 to 5 and metabolic acidosis. The median follow-up was 3.7 years. In adjusted analyses, each 1 mmol/L within-patient increase in serum bicarbonate over time was significantly associated with an 8.4% decreased risk of a composite outcome of a 40% or greater decline in estimated glomerular filtration rate from baseline or evidence of dialysis or transplantation.

“Clinically, physicians often wait for more than one bicarbonate value in the acidosis range to initiate treatment, although all patients with metabolic acidosis are at high risk for progression,” Dr Tangri’s team wrote in Kidney International Reports. “These findings suggest that a patient with a declining serum bicarbonate may be at even greater risk and should be treated promptly.”

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For the study, Dr Tangri’s team used 2007-2019 data from Optum’s de-identified Integrated Claims-Clinical dataset of US patients. The investigators defined metabolic acidosis as an index serum bicarbonate level (in mmol/L) of 12 or higher but less than 22.

Dr Tangri and colleagues concluded that their findings from a real-world population of patients with CKD and metabolic acidosis “demonstrate that a within-patient increase in serum bicarbonate over time is associated with a lower risk of progression of CKD. These findings suggest that both the absolute serum bicarbonate as well as its trajectory should be considered in the decision to treat metabolic acidosis.”

Disclosure: This research was supported by Tricida. Please see the original reference for a full list of disclosures.


Tangri N, Ferguson TW, Reaven N, et al. Increasing serum bicarbonate is associated with reduced risk of adverse kidney outcomes in patients with CKD and metabolic acidosis. Kidney Int Rep. Published online January 31, 2023. doi:10.1016/j.ekir.2023.01.029