The following is a summary of the “Serum Bicarbonate and Graft and Patient Outcomes Among Kidney Transplant Recipients: A Retrospective Cohort Study Evaluating Changes in Serum Bicarbonate Over Time,” published in the January 2023 issue of Kidney Medicine by Mathur, et al.
To increase graft survival, it is important to pinpoint preventable causes of kidney allograft failure. Although eubicarbonatemic metabolic acidosis, in which serum bicarbonate is normal but metabolic acidosis is present, has been linked to the development of native kidney disease, its impact on kidney transplant recipients is unknown. A cohort of kidney transplant recipients with data from 1 year before and after transplantation was generated using an Integrated Claims-Clinical dataset of US patients with chronic kidney disease (estimated glomerular filtration rates 60 mL/min/1.73 m2).
Risk of graft failure, all-cause mortality, major adverse cardiac events, and time to first hospitalization was evaluated using adjusted time-dependent Cox proportional hazards models. Each 1-mEq/L increase in serum bicarbonate was associated with a significantly lower hazard of graft loss, death, major adverse cardiac events, and hospitalization by 10%, 8%, 4%, and 8%, respectively, in this US community-based cohort of 1,915 kidney transplant recipients with a median follow-up of 2.5 years.
Increases in serum bicarbonate by as little as 1 mEq/L were associated with a decreased risk of graft loss, all-cause mortality, cardiovascular events, and hospitalization in a community-based US kidney transplant recipient population. Therefore, research into the efficacy of metabolic acidosis treatments in kidney transplant recipients is needed.