“…We demonstrated distinct risk factors for metabolic acidosis in pediatric KTx recipients such as younger patient age, which is consistent with a recent report in a cohort of 63 pediatric KTx recipients. 22 Several studies have shown that young children require higher doses of tacrolimus to achieve target exposure. 23 , 24 Tacrolimus affects key transport proteins that are involved in acid-base homeostasis in the proximal and distal tubules, including endothelin-1 and H(+)-ATPase transport protein.…”