INDEPENDENT RISK FACTOR FOR CKD PROGRESSION
Metabolic acidosis is both a complication of CKD and a cause of its progression1,4,10,17
Metabolic acidosis is associated with an increased risk of CKD progression and risk of mortality39-44
-
Multiple, large, retrospective cohort analyses have demonstrated that the relationship between decreasing serum bicarbonate levels and clinical outcomes appears to be a continuum: as serum bicarbonate decreases from normal levels, the risk of adverse outcomes like death or progression of CKD progressively increases39-44
- Each 1 mEq/L decline below the normal range of serum bicarbonate (22–29 mEq/L) is associated with a 3%–9% increased risk of CKD progression39-42
- The association of low serum bicarbonate with progression of kidney disease is independent of baseline eGFR and other clinical, demographic and socioeconomic factors39-42
- The association between metabolic acidosis and increasing risk of mortality in non-dialysis-dependent CKD patients and healthy adults with a range of serum bicarbonate values has been demonstrated after adjusting for kidney disease severity and a wide variety of other comorbid conditions42-44
Increasing serum bicarbonate has been shown to slow CKD progression46-49
-
In several, single-center, prospective studies, oral alkali supplementation or reduction of acid production through consumption of a very low protein diet supplemented with ketoanalogs led to reductions in:
- biomarkers of kidney injury and/or net acid excretion45-48
- the rate and extent of eGFR decline25,26,45,47-49
- the proportion of subjects who experienced rapid decline in eGFR (ie, >3 mL/min/1.73m2)25,26
- progression to a renal endpoint (eg, dialysis, creatinine clearance <10 mL/min, >50% reduction in eGFR)25,49
KDIGO guidelines recommend using validated risk prediction tools to evaluate patient risk of progression to kidney failure6
- Based on the work of Dr Navdeep Tangri and colleagues, the 8 variable Kidney Failure Risk Equation (KFRE) predicts the 2-year and 5-year risk of CKD progression to ESRD40
- Serum bicarbonate is one of the 8 variables used in KFRE
- The Neph+ app may be used to calculate patient 2- and 5-year risk of kidney failure as measured by the 8-variable KFRE
Hear from a Nephrologist
Nevdeep Tangri, MD, PhD*:
What is the role of metabolic acidosis in CKD risk prediction?
*Dr Tangri is a paid consultant of TRICIDA, Inc.
Download the Neph+ App
Read more
Goraya N and Wesson DE (2019):
Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease
Go to ARTICLE