Djamali A, et al. - In this observational single-center cohort study of 2,128 kidney transplant recipients free of cardiovascular events (CVEs) in the first 13.5 months after transplantation, researchers investigated if serum bicarbonate (measured as total carbon dioxide [tCO₂] in serum) levels predicted CVEs after kidney transplantation. They used multivariable proportional hazards regression models and restricted cubic spline Poisson models. They found a 38.8% (n = 826) prevalence of metabolic acidosis, defined as tCO₂ level < 24 mEq/L. A median follow-up of 4.0 years revealed the occurrence of a CVE in 384 recipients and 610 deaths. CVEs included 241 ischemic, 137 arrhythmic, and 150 heart failure events. Findings revealed that metabolic acidosis was identified as an independent risk factor for ischemic CVEs after kidney transplantation. Whether correction of acidosis improves outcomes in these patients still remains unknown.