タカハシ　リナ   TAKAHASHI Rina   高橋　利奈    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
言語種別	英語
発表タイトル	Association of Prescribed Sodium Bicarbonate Therapy with All-Cause Mortality in a National Cohort of Veterans with Incident CKD
会議名	Kidney Week 2025
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Takahashi Rina, Kovesdy Csaba P, Tran Diana, Simon Lewis, Elali Ibrahim, Shen Jenny I, Dukkipati Ramanath B, Shah Anuja P, Ismail Adnan M, Thomas Fridtjof, Sumida Keiichi, Rhee Connie, Kalantar-Zadeh Kamyar,
発表年月日	2025/11/06
国名	アメリカ合衆国
開催地 （都市, 国名）	Houston, USA
開催期間	2025/11/05～2025/11/09
学会抄録	Journal of the American Society of Nephrology : JASN 36(10S)
概要	Background Sodium bicarbonate is widely used in CKD to treat metabolic acidosis. While observational studies suggest possible survival benefits, meta-analyses of RCTs show no significant effect on mortality. Some trials also show no benefit in physical function or kidney outcomes. Concerns include sodium load, volume expansion, and metabolic alkalosis. The long-term effect on all-cause mortality remains unclear in large, nationally representative cohorts. Methods We conducted a retrospective cohort study using the national TRI-CKD database, including 50,577 United States veterans with incident CKD, defined by two outpatient eGFR values <60 mL/min/1.73 m2 at least 90 days apart, both ≥25% below baseline, identified from October 1, 2004, to December 31, 2018. Follow-up continued until death or December 31, 2018. Bicarbonate users were defined as those prescribed after CKD onset. Cox proportional hazards models (Models 1–7) assessed all-cause mortality, adjusting for demographics, comorbidities, blood pressure, laboratory values (eGFR, UACR, serum albumin, bicarbonate, calcium), and ACE inhibitor/ARB use. Results Among 50,577 veterans with incident chronic kidney disease (mean age 65.0 years; 97% male), 11,901 received sodium bicarbonate. In unadjusted analysis, bicarbonate use was associated with higher mortality (HR 1.21; 95% CI 1.17–1.25). This association persisted in all adjusted models (HR range 1.09–1.59). In the fully adjusted model (Model 7), it remained significant (HR 1.16; 95% CI 1.11–1.22; see Figure). Conclusion Sodium bicarbonate use was associated with increased all-cause mortality despite extensive adjustment. These findings contrast with prior studies showing benefit or no significant association and highlight the need for careful patient selection and further clinical evaluation.