Introduction:
Men and women respond differently to catabolic conditions. It is postulated that females tolerate chronic inflammation to a lesser degree than males. Apart from kidney disease disease per se, the response of women to metabolic acidosis(MA) can be modified by gender-related factors like low muscle mass and gonadal hormones. There is no data on the gender differences for alkali supplementation to correct MA. The present study looks in to the gender differences in bicarbonate requirements for correction of MA in pre-dialysis Chronic Kidney Disease.
Methods:
The data is derived from a randomized trial published on the utility of bicarbonate supplementation to preserve muscle mass and kidney function in pre-dialysis CKDu. A total of 188 patients with CKD stages 3 and 4 with venous bicarbonate levels <22 meq/L were included - 98 persons(68 males and 26 females ) in the intervention arm received bicarbonate supplements to keep the venous bicarbonate levels to 24-26 meq/L. The present study is based on data from the intervention arm (n=94).
Results:
Males were older compared to females (51.9 ± 10.3 vs 45.5 ± 13.6; P =0.016) and had higher body weight compared to females ((55 ± 7.3 vs 50 ± 8.7; P =0.006). The bicarbonate levels were comparable at baseline (18.1 ± 2.1 for males and 18.1 ± 2.2 meq/L for females; P=0.883). The prevalence of sarcopenia was similar across the genders (67.6% in males and 57.7% in females; P=0.366). The other parameters like eGFR, cholesterol, albumin, uric acid, haemoglobin etc. were comparable between genders. At the end of six months of bicarbonate supplementation, the venous bicarbonate levels were comparable across both genders (23.9 ± 2.2 for males and 23.1 ± 2.5 meq/L for females; P=0.118). However, females needed a higher bicarbonate dosage to reach the target bicarbonate levels (2.2 ± 0.5 gm/day for males and 2.6± 0.5 for females; P=0.00). The difference persisted even after adjustment for body weights . A generalised linear model showed that females needed a higher bicarbonate requirement [0.58 meq/KBW; 95% CI 0.58, 0.62 in females vs 0.50 meq/ KBW; 95% CI 0.47, 0.52 in males; P= 0.008], after adjusting for the effects of age, eGFR and body weight.
Conclusions:
The present study shows that females , despite having a lower body weight, need more bicarbonate requirements for correction of MA.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.