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Low serum bicarbonate and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA).
Am J Kidney Dis. 2014 Oct; 64(4):534-41.AJ

Abstract

BACKGROUND

Among populations with established chronic kidney disease (CKD), metabolic acidosis is associated with more rapid progression of kidney disease. The association of serum bicarbonate concentrations with early declines in kidney function is less clear.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

5,810 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with a baseline estimated glomerular filtration rate (eGFR) > 60mL/min/1.73 m(2) using the CKD-EPI (CKD Epidemiology Collaboration) creatinine-cystatin C equation.

PREDICTORS

Serum bicarbonate concentrations.

OUTCOMES

Rapid kidney function decline (eGFR decline > 5% per year) and incident reduced eGFR (eGFR < 60mL/min/1.73 m(2) with minimum rate of eGFR loss of 1 mL/min/1.73 m(2) per year).

RESULTS

Average bicarbonate concentration was 23.2 ± 1.8mEq/L. 1,730 (33%) participants had rapid kidney function decline, and 487 had incident reduced eGFR during follow-up. Each 1-SD lower baseline bicarbonate concentration was associated with 12% higher adjusted odds of rapid kidney function decline (95% CI, 6%-20%) and higher risk of incident reduced eGFR (adjusted incidence rate ratio, 1.11; 95% CI, 1.03-1.20) in models adjusting for demographics, baseline eGFR, albuminuria, and CKD risk factors. The OR for the associations of bicarbonate level < 21 mEq/L relative to 23-24 mEq/L was 1.35 (95% CI, 1.05-1.73) for rapid kidney function decline, and the incidence rate ratio was 1.16 (95% CI, 0.83-1.62) for incident reduced eGFR.

LIMITATIONS

Cause of metabolic acidosis cannot be determined in this study.

CONCLUSIONS

Lower serum bicarbonate concentrations are associated independently with rapid kidney function decline independent of eGFR or albuminuria in community-living persons with baseline eGFR > 60 mL/min/1.73 m(2). If confirmed, our findings suggest that metabolic acidosis may indicate either early kidney disease that is not captured by eGFR or albuminuria or may have a causal role in the development of eGFR < 60 mL/min/1.73 m(2).

Authors+Show Affiliations

School of Medicine, University of California, San Francisco.Department of Medicine, University of California, San Francisco; Department of Epidemiology and Biostatistics, University of California, San Francisco; Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA.Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA.Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA.Division of Nephrology, Tufts Medical Center, Boston, MA.Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA.Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA; Cardiovascular Health Research Unit, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA.Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA.Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA.Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, CA; Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, San Diego, CA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA. Electronic address: joeix@ucsd.edu.

Pub Type(s)

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

Language

eng

PubMed ID

24953891

Citation

Driver, Todd H., et al. "Low Serum Bicarbonate and Kidney Function Decline: the Multi-Ethnic Study of Atherosclerosis (MESA)." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 64, no. 4, 2014, pp. 534-41.
Driver TH, Shlipak MG, Katz R, et al. Low serum bicarbonate and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2014;64(4):534-41.
Driver, T. H., Shlipak, M. G., Katz, R., Goldenstein, L., Sarnak, M. J., Hoofnagle, A. N., Siscovick, D. S., Kestenbaum, B., de Boer, I. H., & Ix, J. H. (2014). Low serum bicarbonate and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA). American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 64(4), 534-41. https://doi.org/10.1053/j.ajkd.2014.05.008
Driver TH, et al. Low Serum Bicarbonate and Kidney Function Decline: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2014;64(4):534-41. PubMed PMID: 24953891.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low serum bicarbonate and kidney function decline: the Multi-Ethnic Study of Atherosclerosis (MESA). AU - Driver,Todd H, AU - Shlipak,Michael G, AU - Katz,Ronit, AU - Goldenstein,Leonard, AU - Sarnak,Mark J, AU - Hoofnagle,Andrew N, AU - Siscovick,David S, AU - Kestenbaum,Bryan, AU - de Boer,Ian H, AU - Ix,Joachim H, Y1 - 2014/06/18/ PY - 2014/01/28/received PY - 2014/05/04/accepted PY - 2014/6/24/entrez PY - 2014/6/24/pubmed PY - 2015/3/12/medline KW - Serum bicarbonate KW - chronic kidney disease (CKD) KW - disease progression KW - kidney disease trajectory KW - kidney function KW - metabolic acidosis KW - renal disease SP - 534 EP - 41 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: Among populations with established chronic kidney disease (CKD), metabolic acidosis is associated with more rapid progression of kidney disease. The association of serum bicarbonate concentrations with early declines in kidney function is less clear. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 5,810 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with a baseline estimated glomerular filtration rate (eGFR) > 60mL/min/1.73 m(2) using the CKD-EPI (CKD Epidemiology Collaboration) creatinine-cystatin C equation. PREDICTORS: Serum bicarbonate concentrations. OUTCOMES: Rapid kidney function decline (eGFR decline > 5% per year) and incident reduced eGFR (eGFR < 60mL/min/1.73 m(2) with minimum rate of eGFR loss of 1 mL/min/1.73 m(2) per year). RESULTS: Average bicarbonate concentration was 23.2 ± 1.8mEq/L. 1,730 (33%) participants had rapid kidney function decline, and 487 had incident reduced eGFR during follow-up. Each 1-SD lower baseline bicarbonate concentration was associated with 12% higher adjusted odds of rapid kidney function decline (95% CI, 6%-20%) and higher risk of incident reduced eGFR (adjusted incidence rate ratio, 1.11; 95% CI, 1.03-1.20) in models adjusting for demographics, baseline eGFR, albuminuria, and CKD risk factors. The OR for the associations of bicarbonate level < 21 mEq/L relative to 23-24 mEq/L was 1.35 (95% CI, 1.05-1.73) for rapid kidney function decline, and the incidence rate ratio was 1.16 (95% CI, 0.83-1.62) for incident reduced eGFR. LIMITATIONS: Cause of metabolic acidosis cannot be determined in this study. CONCLUSIONS: Lower serum bicarbonate concentrations are associated independently with rapid kidney function decline independent of eGFR or albuminuria in community-living persons with baseline eGFR > 60 mL/min/1.73 m(2). If confirmed, our findings suggest that metabolic acidosis may indicate either early kidney disease that is not captured by eGFR or albuminuria or may have a causal role in the development of eGFR < 60 mL/min/1.73 m(2). SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24953891/Low_serum_bicarbonate_and_kidney_function_decline:_the_Multi_Ethnic_Study_of_Atherosclerosis__MESA__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)00879-8 DB - PRIME DP - Unbound Medicine ER -