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High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients.
BMC Nephrol. 2013 Jan 09; 14:4.BN

Abstract

BACKGROUND

Metabolic acidosis leads to chronic kidney disease (CKD) progression. The guidelines recommend a lower limit of serum bicarbonate level, but no upper limit. For serum bicarbonate level to be clinically useful as a therapeutic target marker, it is necessary to investigate the target serum bicarbonate level within the normal range to prevent CKD progression.

METHODS

One hundred and thirteen elderly CKD patients, whose serum bicarbonate level was controlled within the normal range, were enrolled in this retrospective cohort study in Ibaraki, Japan. Outcome was defined as a decrease of 25% or more in estimated glomerular filtration rate (eGFR) or starting dialysis. We used Cox proportional hazard models adjusted for patients' characteristics to examine the association between serum bicarbonate level and the outcome.

RESULTS

Female patients were 36.3%: average age (SD), 70.4 (6.6) years; eGFR, 25.7 (13.6) ml/min/1.73 m(2); serum bicarbonate level, 27.4 (3.2) mEq/l. Patients with the lowest quartile of serum bicarbonate levels [23.4 (1.8) mEq/l] showed a high risk of CKD progression compared with patients with high serum bicarbonate levels [28.8 (2.3) mEq/l]: adjusted hazard ratio (HR), 3.511 (95% CI, 1.342-9.186). A 1 mEq/l increase in serum bicarbonate level was associated with a low risk of CKD progression: adjusted HR, 0.791 [95% confidence interval (CI), 0.684-0.914].

CONCLUSIONS

In elderly CKD patients, our findings suggest that serum bicarbonate level is independently associated with CKD progression, and that a high serum bicarbonate level is associated with a low risk of CKD progression. A high target serum bicarbonate level within the normal range may be effective for preventing CKD progression.

Authors+Show Affiliations

Department of Nephrology, Tokyo Kyosai Hospital, Meguroku, Japan. tokyo.kyosai.kanda@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23298330

Citation

Kanda, Eiichiro, et al. "High Serum Bicarbonate Level Within the Normal Range Prevents the Progression of Chronic Kidney Disease in Elderly Chronic Kidney Disease Patients." BMC Nephrology, vol. 14, 2013, p. 4.
Kanda E, Ai M, Yoshida M, et al. High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients. BMC Nephrol. 2013;14:4.
Kanda, E., Ai, M., Yoshida, M., Kuriyama, R., & Shiigai, T. (2013). High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients. BMC Nephrology, 14, 4. https://doi.org/10.1186/1471-2369-14-4
Kanda E, et al. High Serum Bicarbonate Level Within the Normal Range Prevents the Progression of Chronic Kidney Disease in Elderly Chronic Kidney Disease Patients. BMC Nephrol. 2013 Jan 9;14:4. PubMed PMID: 23298330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients. AU - Kanda,Eiichiro, AU - Ai,Masumi, AU - Yoshida,Masayuki, AU - Kuriyama,Renjiro, AU - Shiigai,Tatsuo, Y1 - 2013/01/09/ PY - 2012/08/05/received PY - 2013/01/07/accepted PY - 2013/1/10/entrez PY - 2013/1/10/pubmed PY - 2013/7/13/medline SP - 4 EP - 4 JF - BMC nephrology JO - BMC Nephrol VL - 14 N2 - BACKGROUND: Metabolic acidosis leads to chronic kidney disease (CKD) progression. The guidelines recommend a lower limit of serum bicarbonate level, but no upper limit. For serum bicarbonate level to be clinically useful as a therapeutic target marker, it is necessary to investigate the target serum bicarbonate level within the normal range to prevent CKD progression. METHODS: One hundred and thirteen elderly CKD patients, whose serum bicarbonate level was controlled within the normal range, were enrolled in this retrospective cohort study in Ibaraki, Japan. Outcome was defined as a decrease of 25% or more in estimated glomerular filtration rate (eGFR) or starting dialysis. We used Cox proportional hazard models adjusted for patients' characteristics to examine the association between serum bicarbonate level and the outcome. RESULTS: Female patients were 36.3%: average age (SD), 70.4 (6.6) years; eGFR, 25.7 (13.6) ml/min/1.73 m(2); serum bicarbonate level, 27.4 (3.2) mEq/l. Patients with the lowest quartile of serum bicarbonate levels [23.4 (1.8) mEq/l] showed a high risk of CKD progression compared with patients with high serum bicarbonate levels [28.8 (2.3) mEq/l]: adjusted hazard ratio (HR), 3.511 (95% CI, 1.342-9.186). A 1 mEq/l increase in serum bicarbonate level was associated with a low risk of CKD progression: adjusted HR, 0.791 [95% confidence interval (CI), 0.684-0.914]. CONCLUSIONS: In elderly CKD patients, our findings suggest that serum bicarbonate level is independently associated with CKD progression, and that a high serum bicarbonate level is associated with a low risk of CKD progression. A high target serum bicarbonate level within the normal range may be effective for preventing CKD progression. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/23298330/High_serum_bicarbonate_level_within_the_normal_range_prevents_the_progression_of_chronic_kidney_disease_in_elderly_chronic_kidney_disease_patients_ L2 - https://bmcnephrol.biomedcentral.com/articles/10.1186/1471-2369-14-4 DB - PRIME DP - Unbound Medicine ER -