Metabolic Acidosis and Cardiovascular Disease Risk in Children with CKD

Area of Science:

• Pediatric Nephrology
• Cardiovascular Research
• Metabolic Disorders

Background:

• Metabolic acidosis (MA) is common in children with chronic kidney disease (CKD).
• The association between MA and cardiovascular disease (CVD) outcomes is established in adults but understudied in pediatric CKD.
• Serum bicarbonate levels serve as a surrogate marker for MA.

Purpose of the Study:

• To evaluate the association between low serum bicarbonate (MA) and adverse CVD risk in children with CKD.
• To analyze the relationship between serum bicarbonate, blood pressure (BP), and left ventricular mass index (LVMI).

Main Methods:

• Utilized data from 936 children (age ≥1 year) in the CKiD study with eGFR 30-90 ml/min per 1.73m2.
• Employed linear regression models to assess associations between time-varying serum bicarbonate, resting BP, ambulatory BP monitoring (ABPM), and LVMI.
• Adjusted for demographic and clinical covariates, indexing BP for age/sex/height comparisons.

Main Results:

• Lower serum bicarbonate was associated with higher resting BP in fully adjusted models.
• A significant association was found between lower serum bicarbonate and lower ABPM systolic indices (wake and sleep).
• A small but significant increase in LVMI (0.02) was observed with lower serum bicarbonate levels.

Conclusions:

• MA in pediatric CKD is associated with elevated resting BP, reduced ABPM, and increased LVMI.
• Future research should investigate MA and CVD risk across CKD severity, incorporating advanced CVD markers.
• Clinical trials are needed to determine if alkali therapy can reduce CVD risk in this population.