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Metabolic acidosis in pediatric kidney transplant recipients

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Abstract

Background

Metabolic acidosis is a risk factor for faster kidney function decline in chronic kidney disease (CKD) and in adult kidney transplant recipients (KTRs). We hypothesized that metabolic acidosis would be highly prevalent and associated with worse allograft function in pediatric KTRs.

Methods

Pediatric KTRs at Montefiore Medical Center from 2010 to 2018 were included. Metabolic acidosis was defined as serum bicarbonate < 22 mEq/L or receiving alkali therapy. Regression models were adjusted for demographic factors and donor/recipient characteristics.

Results

Sixty-three patients were identified with a median age at transplant of 10.5 (interquartile range (IQR) 4.4–15.2) years and post-transplant follow-up of 3 (IQR 1–5) years. Baseline serum bicarbonate was 21.7 ± 2.4 mEq/L, serum bicarbonate < 22 mEq/L was present in 28 (44%), and 44% of all patients were receiving alkali therapy. The prevalence of acidosis ranged from 58 to 70% during the first year of follow-up. At baseline, each 1-year higher age at transplant and every 10 ml/min/1.73 m2 higher eGFR were associated with 0.16 mEq/L (95% CI: 0.03–0.3) and 0.24 mEq/L (95% CI: 0.01–0.5) higher serum bicarbonate, respectively. Older age at transplant was associated with lower odds of acidosis (OR: 0.84; 95% CI: 0.72–0.97). During follow-up, metabolic acidosis was independently associated with 8.2 ml/min/1.73 m2 (95% CI 4.4–12) lower eGFR compared to not having acidosis; furthermore, eGFR was significantly lower among KTRs with unresolved acidosis compared with resolved acidosis.

Conclusions

Among pediatric KTRs, metabolic acidosis was highly prevalent in the first year post-transplantation and was associated with lower eGFR during follow-up.

Graphical abstract

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Data availability

Due to concerns over maintenance of patient confidentiality, the dataset is not publicly available but may be available from the corresponding author on reasonable request.

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Acknowledgements

The author SK would like to thank Drs. Frederick Kaskel and Dr. Michal Melamed as the research described was supported by the TL1DK136048 New York Consortium for Interdisciplinary Training on Kidney, Urological and Hematological Research (NYC Train KUHR) as well as by the NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number 1UM1TR004400. KJR is supported by R01DK131811 and R01DK131176.

Funding

This study was funded by the TL1DK136048 New York Consortium for Interdisciplinary Training on Kidney, Urological and Hematological Research (NYC Train KUHR) and by the NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number UL1TR001073.

Author information

Authors and Affiliations

  1. The Children’s Hospital at Montefiore/Einstein, Bronx, NY, USA

    Stella Kilduff, Nicole Hayde & Kimberly Reidy

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Stella Kilduff & Shankar Viswanathan

  3. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Matthew K. Abramowitz

  4. Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA

    Matthew K. Abramowitz

  5. Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Matthew K. Abramowitz

  6. Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA

    Matthew K. Abramowitz

Authors
  1. Stella Kilduff
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  2. Nicole Hayde
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  3. Shankar Viswanathan
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  4. Kimberly Reidy
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  5. Matthew K. Abramowitz
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Corresponding author

Correspondence to Stella Kilduff.

Ethics declarations

Ethical approval

The study was approved by the institutional review board for Montefiore Medical Center / Albert Einstein College of Medicine (IRB Number: 2021–13548).

Informed consent

The need for informed consent was waived due to the use of de-identified data.

Conflict of interest

Stella Kilduff has grant funding by TL1DK136048 and UL1TR001073. Author Kimberly Reidy has grants supported by R01DK131811 and R01DK131176. Dr. Kimberly Reidy is also a site investigator for Advicienne and Travere Therapeutics funded clinical trials that are unrelated to this manuscript. Authors Stella Kilduff, Nicole Hayde, Shankar Viswanathan, and Matthew Abramowitz declare that they have no conflicts of interest or disclosures.

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Kilduff, S., Hayde, N., Viswanathan, S. et al. Metabolic acidosis in pediatric kidney transplant recipients. Pediatr Nephrol 38, 4165–4173 (2023). https://doi.org/10.1007/s00467-023-06072-z

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  • DOI: https://doi.org/10.1007/s00467-023-06072-z

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