Metabolic Acidosis and the Risk of Progression to Diabetes in Patients with Prediabetes and CKD
Bibliographic record
Abstract
Background: Diabetes and metabolic acidosis are known risk factors for progression of CKD. Treatment of metabolic acidosis has been shown to reduce insulin resistance among patients with CKD and diabetes, but whether metabolic acidosis predicts progression from prediabetes to diabetes among patients with CKD is unknown. Methods: Optum's de-identified Integrated Claims-Clinical dataset of US patients (2007-2019) was queried for patients with non-dialysis CKD stages 3-5 with 2 consecutive serum bicarbonate of 12 to <22 mEq/L (metabolic acidosis) or 22 to <30 mEq/L (normal serum bicarbonate) with ≥1 year prior data and ≥2 years of post-index data or death within 2 years. Patients with prediabetes (HbA1c 5.7 to <6.5%, fasting plasma glucose 100 to <126 mg/dL, or 75 g oral glucose challenge 140-199 mg/dL) were followed for up to 11.5 years for incident diabetes identified through lab values, diagnosis, or prescriptions. Cox proportional hazards models were used to evaluate metabolic acidosis as a predictor of incident diabetes, adjusting for age, sex, race, low-income status, geo-coded education level, and baseline BMI, eGFR, metabolic syndrome and polycystic ovary syndrome. Death was also evaluated as a competing risk. Results: 7156/136,067 patients had evidence of prediabetes during the pre-index year. 47% (136/292) of patients with baseline metabolic acidosis and 46% (3143/6864) with normal serum bicarbonate developed diabetes during the outcome period (P=0.8). Patients with metabolic acidosis developed diabetes sooner on average compared with normal serum bicarbonate (544 vs 643 days); however, baseline metabolic acidosis was not a significant predictor of time to incident diabetes in adjusted analyses (HR 1.20, 95% CI:0.96-1.49). Metabolic syndrome (HR 1.26, 95% CI:1.08 1.46), Black race (HR 1.28 [1.11-1.47]), male sex (HR 1.11[1.01-1.21]), and higher BMI (HR 1.03 [1.02-1.03]) were associated with a higher risk of progression to diabetes. Higher baseline eGFR was associated with lower risk of progression to diabetes (HR 0.993 [0.988 0.997]). Conclusions: In this longitudinal analysis of non-dialysis CKD stages 3-5 patients with prediabetes, metabolic acidosis was not associated with progression to diabetes. Funding: Commercial Support - Tricida, Inc.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".