Tangri N, Reaven NL, Funk SE, et al. - Researchers undertook this longitudinal, retrospective cohort study to quantify the link of metabolic acidosis with chronic kidney disease (CKD) progression as well as mortality in a large U.S. community-based cohort. Using Optum’s de-identified integrated electronic health records, they selected non-dialysis-dependent patients with stage 3‒5 CKD. This study involved 51,558 patients. In the metabolic acidosis group, there was significantly worse unadjusted 2-year incidence of adverse renal and fatal outcomes when compared with those who had normal serum bicarbonate concentrations. Findings revealed that metabolic acidosis, when present, represented a significant, independent risk factor for the composite adverse outcome of CKD progression, renal replacement therapy, and all-cause mortality (DD40: a >40% reduction in estimated glomerular filtration rate, renal replacement therapy, or all-cause mortality) in this large community cohort of patients suffering from stage 3‒5 CKD.