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Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: a report from the Chronic Renal Insufficiency Cohort (CRIC) study.
Am J Kidney Dis. 2013 Oct; 62(4):670-8.AJ

Abstract

BACKGROUND

The purpose of this study is to evaluate serum bicarbonate level as a risk factor for renal outcomes, cardiovascular events, and mortality in patients with chronic kidney disease (CKD).

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS

3,939 participants with CKD stages 2-4 who enrolled in the Chronic Renal Insufficiency Cohort (CRIC) between June 2003 and December 2008.

PREDICTOR

Serum bicarbonate level.

OUTCOMES

Renal outcomes, defined as end-stage renal disease (either initiation of dialysis therapy or kidney transplantation) or 50% reduction in estimated glomerular filtration rate (eGFR); atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease); congestive heart failure events; and death.

MEASUREMENTS

Time to event.

RESULTS

Mean eGFR was 44.8 ± 16.8 (SD) mL/min/1.73 m(2), and median serum bicarbonate level was 24 (IQR, 22-26) mEq/L. During a median follow-up of 3.9 years, 374 participants died, 767 had a renal outcome, 332 experienced an atherosclerotic event, and 391 had a congestive heart failure event. In adjusted analyses, the risk of developing a renal end point was 3% lower per 1-mEq/L increase in serum bicarbonate level (HR, 0.97; 95% CI, 0.94-0.99; P = 0.01). The association was stronger for participants with eGFR >45 mL/min/1.73 m(2) (HR, 0.91; 95% CI, 0.85-0.97; P = 0.004). The risk of heart failure increased by 14% (HR, 1.14; 95% CI, 1.03-1.26; P = 0.02) per 1-mEq/L increase in serum bicarbonate level over 24 mEq/L. Serum bicarbonate level was not associated independently with atherosclerotic events (HR, 0.99; 95% CI, 0.95-1.03; P = 0.6) and all-cause mortality (HR, 0.98; 95% CI, 0.95-1.02; P = 0.3).

LIMITATIONS

Single measurement of sodium bicarbonate.

CONCLUSIONS

In a cohort of participants with CKD, low serum bicarbonate level was an independent risk factor for kidney disease progression, particularly for participants with preserved kidney function. The risk of heart failure was higher at the upper extreme of serum bicarbonate levels. There was no association between serum bicarbonate level and all-cause mortality or atherosclerotic events.

Authors+Show Affiliations

Case Western Reserve University, Cleveland, OH; Division of Nephrology and Hypertension, University Hospital Case Medical Center, Cleveland, OH; Louis Stokes Cleveland VA Medical Center, Cleveland, OH. Electronic address: mirela.dobre@uhhospitals.org.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23489677

Citation

Dobre, Mirela, et al. "Association of Serum Bicarbonate With Risk of Renal and Cardiovascular Outcomes in CKD: a Report From the Chronic Renal Insufficiency Cohort (CRIC) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 62, no. 4, 2013, pp. 670-8.
Dobre M, Yang W, Chen J, et al. Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: a report from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis. 2013;62(4):670-8.
Dobre, M., Yang, W., Chen, J., Drawz, P., Hamm, L. L., Horwitz, E., Hostetter, T., Jaar, B., Lora, C. M., Nessel, L., Ojo, A., Scialla, J., Steigerwalt, S., Teal, V., Wolf, M., & Rahman, M. (2013). Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: a report from the Chronic Renal Insufficiency Cohort (CRIC) study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 62(4), 670-8. https://doi.org/10.1053/j.ajkd.2013.01.017
Dobre M, et al. Association of Serum Bicarbonate With Risk of Renal and Cardiovascular Outcomes in CKD: a Report From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2013;62(4):670-8. PubMed PMID: 23489677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: a report from the Chronic Renal Insufficiency Cohort (CRIC) study. AU - Dobre,Mirela, AU - Yang,Wei, AU - Chen,Jing, AU - Drawz,Paul, AU - Hamm,L Lee, AU - Horwitz,Edward, AU - Hostetter,Thomas, AU - Jaar,Bernard, AU - Lora,Claudia M, AU - Nessel,Lisa, AU - Ojo,Akinlolu, AU - Scialla,Julia, AU - Steigerwalt,Susan, AU - Teal,Valerie, AU - Wolf,Myles, AU - Rahman,Mahboob, AU - ,, Y1 - 2013/03/13/ PY - 2012/08/02/received PY - 2013/01/15/accepted PY - 2013/3/16/entrez PY - 2013/3/16/pubmed PY - 2013/11/16/medline KW - Metabolic acidosis KW - cardiovascular morbidity KW - chronic kidney disease KW - serum bicarbonate SP - 670 EP - 8 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 62 IS - 4 N2 - BACKGROUND: The purpose of this study is to evaluate serum bicarbonate level as a risk factor for renal outcomes, cardiovascular events, and mortality in patients with chronic kidney disease (CKD). STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 3,939 participants with CKD stages 2-4 who enrolled in the Chronic Renal Insufficiency Cohort (CRIC) between June 2003 and December 2008. PREDICTOR: Serum bicarbonate level. OUTCOMES: Renal outcomes, defined as end-stage renal disease (either initiation of dialysis therapy or kidney transplantation) or 50% reduction in estimated glomerular filtration rate (eGFR); atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease); congestive heart failure events; and death. MEASUREMENTS: Time to event. RESULTS: Mean eGFR was 44.8 ± 16.8 (SD) mL/min/1.73 m(2), and median serum bicarbonate level was 24 (IQR, 22-26) mEq/L. During a median follow-up of 3.9 years, 374 participants died, 767 had a renal outcome, 332 experienced an atherosclerotic event, and 391 had a congestive heart failure event. In adjusted analyses, the risk of developing a renal end point was 3% lower per 1-mEq/L increase in serum bicarbonate level (HR, 0.97; 95% CI, 0.94-0.99; P = 0.01). The association was stronger for participants with eGFR >45 mL/min/1.73 m(2) (HR, 0.91; 95% CI, 0.85-0.97; P = 0.004). The risk of heart failure increased by 14% (HR, 1.14; 95% CI, 1.03-1.26; P = 0.02) per 1-mEq/L increase in serum bicarbonate level over 24 mEq/L. Serum bicarbonate level was not associated independently with atherosclerotic events (HR, 0.99; 95% CI, 0.95-1.03; P = 0.6) and all-cause mortality (HR, 0.98; 95% CI, 0.95-1.02; P = 0.3). LIMITATIONS: Single measurement of sodium bicarbonate. CONCLUSIONS: In a cohort of participants with CKD, low serum bicarbonate level was an independent risk factor for kidney disease progression, particularly for participants with preserved kidney function. The risk of heart failure was higher at the upper extreme of serum bicarbonate levels. There was no association between serum bicarbonate level and all-cause mortality or atherosclerotic events. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/23489677/Association_of_serum_bicarbonate_with_risk_of_renal_and_cardiovascular_outcomes_in_CKD:_a_report_from_the_Chronic_Renal_Insufficiency_Cohort__CRIC__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)00108-X DB - PRIME DP - Unbound Medicine ER -