Kajimoto S, Sakaguchi Y, Asahina Y, et al. - This retrospective cohort study was designed to determine the impact of pH on the link between hypobicarbonatemia and incident kidney failure needing replacement therapy (KFRT). Participants were Japanese patients (n = 1,058) with eGFR less than 60 mL/min/1.73m². A 2.29-fold higher rate of KFRT was observed in relation to the lowest (vs the highest) quartile of bicarbonate in patients with acidemia (pH<7.32), following adjustment for potential confounders, including capacity for respiratory compensation. No significant link was evident between bicarbonate and KFRT in those without acidemia (pH ≥ 7.32). Overall, findings demonstrated that the link of hypobicarbonatemia with progression of chronic kidney disease (CKD) to KFRT was altered by venous pH. Experts suggested the likely usefulness of venous pH measurement for detecting patients with CKD and hypobicarbonatemia and for informing treatment.