Increased serum bicarbonate correlates with reduced risk of kidney transplant loss, death
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Increases in serum bicarbonate, even at a small level, correlated with reduced risk of graft loss, all-cause mortality, cardiovascular events and hospitalization, according to data published in Kidney Medicine.
“Kidney transplantation is a life-saving procedure that allows patients with kidney failure to live without dialysis treatments. However, kidney transplants often fail during the lifetime of the recipient, requiring them to return to dialysis. We need to identify treatable factors that contribute to kidney transplant failure,” Vandana Mathur, MD, and colleagues wrote.
In a retrospective cohort study, researchers explored the effect of metabolic acidosis with either low serum bicarbonate or normal serum bicarbonate on 1,915 kidney transplant recipients with chronic kidney disease. Data were derived from an Integrated Claims-Clinical dataset (Optum) of U.S. patients between 2007 and 2019, which researchers used with serum bicarbonate data ( three serum bicarbonate results with at least one result between 12 mEq/L and 29 mEq/L) to create the cohort.
Researchers considered a change in serum bicarbonate from baseline the primary predictor for outcomes of graft failure and all-cause mortality. Using adjusted time-dependent Cox proportional hazards models, they measured the risk of graft failure, all-cause mortality, major adverse cardiac events and time to first hospitalization.
After a median follow-up of about 2.5 years, researchers observed a correlation between each 1-mEq/L increase in serum bicarbonate and significantly lower hazard of graft loss, death, major adverse cardiac events and hospitalization by 10%, 8%, 4% and 8%, respectively. Overall, 39% of the kidney transplant recipients experienced graft failure during the outcome period of the study, 13% died, 25% experienced major cardiac events and 41% were hospitalized.
“Our findings suggest that rising serum bicarbonate even among patients with serum bicarbonate in the normal range was associated with better outcomes. The optimal serum bicarbonate that is associated with better outcomes may be in the upper end of the normal range.” Mathur and colleagues wrote. They added, “These findings are important because they may lead to studies to determine if treatments aimed at increasing serum bicarbonate benefit longevity of kidney transplants.”
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