Low serum bicarbonate linked to higher risk of CKD progression in children
Metabolic acidosis, measured by low serum bicarbonate, was linked to a higher risk of chronic kidney disease progression in children with glomerular disease, according to findings from a published study.
“Pediatric CKD exacts a large clinical and economic toll,” Denver D. Brown, MD, from the division of nephrology at Children’s National Hospital, and colleagues wrote. “Children with CKD have higher risk for hospitalizations, metabolic abnormalities, cardiovascular disease, growth restriction and cognitive impairment.”
In a prospective cohort study of pediatric patients aged 6 months to 16 years with mild to moderate CKD, 603 patients with non-glomerular disease and 255 patients with glomerular disease were included. Patients were analyzed for CKD progression of a 50% decline in baseline eGFR after exposure to serum bicarbonate. Analysis was stratified by glomerular diagnoses and adjusted for alkali therapy utilization.
Baseline measurements yielded 39% of patients with non-glomerular disease had a bicarbonate level of at least 22 mEq/L, with 36% reporting alkali therapy treatment. In patients with glomerular disease, 31% had a bicarbonate level of at least 22 mEq/L, with 18% reporting alkali therapy treatment.
Further adjusted longitudinal analyses compared non-glomerular disease patients with a bicarbonate level of greater than 22 mEq/L, hazard ratios associated with a bicarbonate level of less than 18 mEq/L were calculated at 1.28 and bicarbonate level of less than 19 mEq/L to 22 mEq/L at 0.91. In patients with glomerular disease, adjusted hazard ratios associated with bicarbonate level of at least 18 mEq/L were calculated as 2.16 and bicarbonate of at least 19 22 mEq/L to 22 mEq/L at 1.74.
“Low serum bicarbonate was associated with more rapid progression of CKD in children, even after adjustment for clinical confounders ... we also demonstrated that alkali therapy use in pediatric CKD may be underutilized,” Brown and colleagues concluded. “Future studies should evaluate determinants of acidosis and prospectively evaluate ... whether treatment of metabolic acidosis improves outcomes ... in pediatric CKD.”
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