Low Serum Bicarbonate and CKD Progression in Children

Area of Science:

• Pediatric Nephrology
• Renal Medicine
• Clinical Research

Background:

• Metabolic acidosis, indicated by low serum bicarbonate, is linked to chronic kidney disease (CKD) progression in adults.
• The relationship between serum bicarbonate and CKD progression in pediatric populations requires further investigation.

Purpose of the Study:

• To evaluate the association between serum bicarbonate levels and CKD progression in children.
• To determine if low bicarbonate levels impact the composite endpoint of 50% eGFR decline or kidney replacement therapy (KRT) in pediatric CKD patients.

Main Methods:

• Utilized data from the Chronic Kidney Disease in Children study.
• Employed parametric and semiparametric survival methods to analyze the relationship between serum bicarbonate and CKD progression.
• Stratified analyses by nonglomerular and glomerular diagnoses, adjusting for key clinical and demographic factors.

Main Results:

• In children with glomerular disease, lower serum bicarbonate (≤18 meq/L and 19-22 meq/L) was associated with significantly increased hazard ratios for CKD progression (2.16 and 1.74, respectively).
• In children with nonglomerular disease, the association between low bicarbonate and CKD progression was not statistically significant after adjustments.
• Resolution of low bicarbonate levels correlated with a reduced risk of CKD progression compared to persistent low bicarbonate.

Conclusions:

• Low serum bicarbonate is a significant risk factor for CKD progression in children with glomerular disease.
• Alkali therapy was underreported in children with low bicarbonate, suggesting a potential gap in treatment.
• Further long-term studies are warranted to explore the efficacy of alkali therapy in pediatric CKD.