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Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study.
Am J Kidney Dis. 2014 Oct; 64(4):542-9.AJ

Abstract

BACKGROUND

In populations with prevalent chronic kidney disease (CKD), lower serum bicarbonate levels are associated with more rapid CKD progression, but whether lower bicarbonate levels also are associated with risk of incident estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) and CKD progression among community-living persons with predominantly preserved kidney function is unknown.

STUDY DESIGN

Longitudinal observational cohort study.

SETTING & PARTICIPANTS

Well-functioning community-living elders aged 70-79 years at inception.

PREDICTOR

Serum bicarbonate level measured at the time of collection by arterialized venous blood sample using an arterial blood gas analyzer.

OUTCOMES

Change in eGFR over 7 years, and new eGFR < 60 mL/min/1.73 m(2) with a rate of loss of at least 1 mL/min/1.73 m(2) per year.

MEASUREMENTS

Linear and logistic regressions were used to evaluate associations of baseline serum bicarbonate level with change in eGFR and incident eGFR < 60 mL/min/1.73 m(2).

RESULTS

At baseline, mean eGFR was 84 ± 16 (SD)mL/min/1.73 m(2), and serum bicarbonate level was 25.2 ± 1.9 mmol/L. Compared with participants with higher bicarbonate concentrations (23.0-28.0 mmol/L), those with bicarbonate concentrations < 23 mmol/L (n = 85 [8%]) lost eGFR0.55 (95% CI, 0.13-0.97) mL/min/1.73 m(2) per year faster in models adjusted for demographics, CKD risk factors, baseline eGFR, and urine albumin-creatinine ratio. Among the 989 (92%) participants with baseline eGFRs > 60 mL/min/1.73 m(2), 252 (25%) developed incident eGFRs < 60 mL/min/1.73 m(2) at follow-up. Adjusting for the same covariates, participants with bicarbonate concentrations < 23 mmol/L had nearly 2-fold greater odds of incident eGFRs < 60 mL/min/1.73 m(2) (OR, 1.72; 95% CI, 0.97-3.07) compared with those with higher bicarbonate concentrations.

LIMITATIONS

Only 2 measurements of kidney function separated by 7 years and loss to follow-up due to intervening mortality in this elderly population.

CONCLUSIONS

Lower serum bicarbonate concentrations are associated independently with decline in eGFR and incident eGFR < 60 mL/min/1.73 m(2) in community-living older persons. If confirmed, serum bicarbonate levels may give insight into kidney tubule health in persons with preserved eGFRs and suggest a possible new target for intervention to prevent CKD development.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA.Department of Medicine, University of California, San Francisco, San Francisco, CA.Nephrology Section, Veterans Affairs Hospital, Pittsburgh, PA; Division of Nephrology, Department of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA; Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA.Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, UT.Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD.Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC.Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.Department of Medicine, University of California, San Francisco, San Francisco, CA; General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA; Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA. Electronic address: joeix@ucsd.edu.No affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

24953890

Citation

Goldenstein, Leonard, et al. "Serum Bicarbonate Concentrations and Kidney Disease Progression in Community-living Elders: the Health, Aging, and Body Composition (Health ABC) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 64, no. 4, 2014, pp. 542-9.
Goldenstein L, Driver TH, Fried LF, et al. Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study. Am J Kidney Dis. 2014;64(4):542-9.
Goldenstein, L., Driver, T. H., Fried, L. F., Rifkin, D. E., Patel, K. V., Yenchek, R. H., Harris, T. B., Kritchevsky, S. B., Newman, A. B., Sarnak, M. J., Shlipak, M. G., & Ix, J. H. (2014). Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 64(4), 542-9. https://doi.org/10.1053/j.ajkd.2014.05.009
Goldenstein L, et al. Serum Bicarbonate Concentrations and Kidney Disease Progression in Community-living Elders: the Health, Aging, and Body Composition (Health ABC) Study. Am J Kidney Dis. 2014;64(4):542-9. PubMed PMID: 24953890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study. AU - Goldenstein,Leonard, AU - Driver,Todd H, AU - Fried,Linda F, AU - Rifkin,Dena E, AU - Patel,Kushang V, AU - Yenchek,Robert H, AU - Harris,Tamara B, AU - Kritchevsky,Stephen B, AU - Newman,Anne B, AU - Sarnak,Mark J, AU - Shlipak,Michael G, AU - Ix,Joachim H, AU - ,, Y1 - 2014/06/18/ PY - 2014/03/12/received PY - 2014/05/07/accepted PY - 2014/6/24/entrez PY - 2014/6/24/pubmed PY - 2015/3/12/medline KW - Acidosis KW - aging KW - alkalosis KW - disease progression KW - kidney disease KW - kidney disease trajectory KW - renal disease KW - risk factor SP - 542 EP - 9 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 64 IS - 4 N2 - BACKGROUND: In populations with prevalent chronic kidney disease (CKD), lower serum bicarbonate levels are associated with more rapid CKD progression, but whether lower bicarbonate levels also are associated with risk of incident estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) and CKD progression among community-living persons with predominantly preserved kidney function is unknown. STUDY DESIGN: Longitudinal observational cohort study. SETTING & PARTICIPANTS: Well-functioning community-living elders aged 70-79 years at inception. PREDICTOR: Serum bicarbonate level measured at the time of collection by arterialized venous blood sample using an arterial blood gas analyzer. OUTCOMES: Change in eGFR over 7 years, and new eGFR < 60 mL/min/1.73 m(2) with a rate of loss of at least 1 mL/min/1.73 m(2) per year. MEASUREMENTS: Linear and logistic regressions were used to evaluate associations of baseline serum bicarbonate level with change in eGFR and incident eGFR < 60 mL/min/1.73 m(2). RESULTS: At baseline, mean eGFR was 84 ± 16 (SD)mL/min/1.73 m(2), and serum bicarbonate level was 25.2 ± 1.9 mmol/L. Compared with participants with higher bicarbonate concentrations (23.0-28.0 mmol/L), those with bicarbonate concentrations < 23 mmol/L (n = 85 [8%]) lost eGFR0.55 (95% CI, 0.13-0.97) mL/min/1.73 m(2) per year faster in models adjusted for demographics, CKD risk factors, baseline eGFR, and urine albumin-creatinine ratio. Among the 989 (92%) participants with baseline eGFRs > 60 mL/min/1.73 m(2), 252 (25%) developed incident eGFRs < 60 mL/min/1.73 m(2) at follow-up. Adjusting for the same covariates, participants with bicarbonate concentrations < 23 mmol/L had nearly 2-fold greater odds of incident eGFRs < 60 mL/min/1.73 m(2) (OR, 1.72; 95% CI, 0.97-3.07) compared with those with higher bicarbonate concentrations. LIMITATIONS: Only 2 measurements of kidney function separated by 7 years and loss to follow-up due to intervening mortality in this elderly population. CONCLUSIONS: Lower serum bicarbonate concentrations are associated independently with decline in eGFR and incident eGFR < 60 mL/min/1.73 m(2) in community-living older persons. If confirmed, serum bicarbonate levels may give insight into kidney tubule health in persons with preserved eGFRs and suggest a possible new target for intervention to prevent CKD development. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24953890/Serum_bicarbonate_concentrations_and_kidney_disease_progression_in_community_living_elders:_the_Health_Aging_and_Body_Composition__Health_ABC__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)00880-4 DB - PRIME DP - Unbound Medicine ER -