Patients with CKD, metabolic acidosis have increased adverse kidney outcomes, costs
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Key takeaways
- Patients with CKD and metabolic acidosis experience more frequent adverse kidney outcomes than patients with normal serum bicarbonate.
- Each 1-mEq/L increase in serum bicarbonate correlates with improved kidney outcomes and health care costs.
Among patients with chronic kidney disease, the presence of metabolic acidosis is associated with an increased risk of adverse kidney outcomes and health care costs, according to data published in Kidney Medicine.
“Despite reported associations between metabolic acidosis and CKD progression and between CKD progression and higher costs, there is scant real-world information about the impact of metabolic acidosis on costs associated with CKD,” Nancy L. Reaven, lead author and president of Strategic Health Resources, and colleagues wrote.
In a retrospective cohort study, researchers examined data of 51,558 patients with stage G3 to G5 CKD and serum bicarbonate values of either 12 mEq/L to less than 22 mEq/L or 22 mEq/L to 29 mEq/L. These groups were identified as the metabolic acidosis group and normal serum bicarbonate group, respectively. Data were derived from the Optum Integrated Claims-Clinical dataset between January 2008 and March 2017.
With baseline serum bicarbonate serving as the exposure, researchers considered the composite of all-cause mortality, maintenance dialysis, kidney transplant or a decline in eGFR of at least 40% to be the primary outcome. Additionally, researchers defined the primary cost outcome during a 2-year period as all-cause predicted per patient per year cost.
Using logistic and generalized linear regression models, researchers measured serum bicarbonate as a predictor of death, dialysis or 40% reduction in eGFR (DD40) and health care costs. Models were adjusted for covariates.
Analyses revealed 48.3% of the metabolic acidosis group experienced DD40 compared with 16.7% of the normal serum bicarbonate group. The metabolic acidosis group also had higher all-cause yearly health care cost at $65,172 compared with the $24,681 for the other group.
Furthermore, researchers identified each 1-mEq/L increase in serum bicarbonate correlated with a 13% reduction in 2-year DD40 events and a 7% decrease in per patient per year costs.
“The association between metabolic acidosis and adverse kidney outcomes confirms findings from multiple, large observational studies and supports current recommendations to treat metabolic acidosis in order to delay CKD progression. The association of metabolic acidosis with increased costs and higher health care utilization is a novel finding and deserves further study,” Reaven and colleagues wrote. “Clinical trials of treatments for metabolic acidosis should add outcomes, such as inpatient visits and emergency department utilization, plus related economic analyses. The multi-organ adverse effects of metabolic acidosis (eg, on bone, muscle, kidney and cardiovascular system) suggest that successful treatment may impact a range of outcomes and related costs that extend beyond the kidney system.”
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