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Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): A report from the Chronic Renal Insufficiency Cohort (CRIC) study.
J Am Heart Assoc. 2015 Apr 20; 4(4)JA

Abstract

BACKGROUND

Serum bicarbonate varies over time in chronic kidney disease (CKD) patients, and this variability may portend poor cardiovascular outcomes. The aim of this study was to conduct a time-updated longitudinal analysis to evaluate the association of serum bicarbonate with long-term clinical outcomes: heart failure, atherosclerotic events, renal events (halving of estimated glomerular filtration rate [eGFR] or end-stage renal disease), and mortality.

METHODS AND RESULTS

Serum bicarbonate was measured annually, in 3586 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Marginal structural models were created to allow for integration of all available bicarbonate measurements and proper adjustment for time-dependent confounding. During the 6 years follow-up, 512 participants developed congestive heart failure (26/1000 person-years) and 749 developed renal events (37/1000 person-years). The risk of heart failure and death was significantly higher for participants who maintained serum bicarbonate >26 mmol/L for the entire duration of follow-up (hazard ratio [HR] 1.66; 95% confidence interval [CI], 1.23 to 2.23, and HR 1.36, 95% CI 1.02 to 1.82, respectively) compared with participants who kept their bicarbonate 22 to 26 mmol/L, after adjusting for demographics, co-morbidities, medications including diuretics, eGFR, and proteinuria. Participants who maintained serum bicarbonate <22 mmol/L had almost a 2-fold increased risk of renal disease progression (HR 1.97; 95% CI, 1.50 to 2.57) compared with participants with bicarbonate 22 to 26 mmol/L.

CONCLUSION

In this large CKD cohort, persistent serum bicarbonate >26 mmol/L was associated with increased risk of heart failure events and mortality. Further studies are needed to determine the optimal range of serum bicarbonate in CKD to prevent adverse clinical outcomes.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.).Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).Department of Medicine, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Epidemiology, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.).St. John Hospital and Medical Center Detroit, MI (K.B.).Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., H.).Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).Jesse Brown VAMC and University of Illinois Hospital and Health Sciences System, Chicago, IL (M.J.F.).Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., H.).Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.).Department of Medicine, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Epidemiology, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.).Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (R.R.K.).Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.).Duke University School of Medicine, Durham, NC (J.J.S.).Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL (M.W.).Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.) Louis Stokes Cleveland VA Medical Center, Cleveland, OH (M.R.).No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

25896890

Citation

Dobre, Mirela, et al. "Persistent High Serum Bicarbonate and the Risk of Heart Failure in Patients With Chronic Kidney Disease (CKD): a Report From the Chronic Renal Insufficiency Cohort (CRIC) Study." Journal of the American Heart Association, vol. 4, no. 4, 2015.
Dobre M, Yang W, Pan Q, et al. Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): A report from the Chronic Renal Insufficiency Cohort (CRIC) study. J Am Heart Assoc. 2015;4(4).
Dobre, M., Yang, W., Pan, Q., Appel, L., Bellovich, K., Chen, J., Feldman, H., Fischer, M. J., Ham, L. L., Hostetter, T., Jaar, B. G., Kallem, R. R., Rosas, S. E., Scialla, J. J., Wolf, M., & Rahman, M. (2015). Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): A report from the Chronic Renal Insufficiency Cohort (CRIC) study. Journal of the American Heart Association, 4(4). https://doi.org/10.1161/JAHA.114.001599
Dobre M, et al. Persistent High Serum Bicarbonate and the Risk of Heart Failure in Patients With Chronic Kidney Disease (CKD): a Report From the Chronic Renal Insufficiency Cohort (CRIC) Study. J Am Heart Assoc. 2015 Apr 20;4(4) PubMed PMID: 25896890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): A report from the Chronic Renal Insufficiency Cohort (CRIC) study. AU - Dobre,Mirela, AU - Yang,Wei, AU - Pan,Qiang, AU - Appel,Lawrence, AU - Bellovich,Keith, AU - Chen,Jing, AU - Feldman,Harold, AU - Fischer,Michael J, AU - Ham,L L, AU - Hostetter,Thomas, AU - Jaar,Bernard G, AU - Kallem,Radhakrishna R, AU - Rosas,Sylvia E, AU - Scialla,Julia J, AU - Wolf,Myles, AU - Rahman,Mahboob, AU - ,, Y1 - 2015/04/20/ PY - 2015/4/22/entrez PY - 2015/4/22/pubmed PY - 2016/4/20/medline KW - CKD KW - heart failure KW - serum bicarbonate JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 4 IS - 4 N2 - BACKGROUND: Serum bicarbonate varies over time in chronic kidney disease (CKD) patients, and this variability may portend poor cardiovascular outcomes. The aim of this study was to conduct a time-updated longitudinal analysis to evaluate the association of serum bicarbonate with long-term clinical outcomes: heart failure, atherosclerotic events, renal events (halving of estimated glomerular filtration rate [eGFR] or end-stage renal disease), and mortality. METHODS AND RESULTS: Serum bicarbonate was measured annually, in 3586 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Marginal structural models were created to allow for integration of all available bicarbonate measurements and proper adjustment for time-dependent confounding. During the 6 years follow-up, 512 participants developed congestive heart failure (26/1000 person-years) and 749 developed renal events (37/1000 person-years). The risk of heart failure and death was significantly higher for participants who maintained serum bicarbonate >26 mmol/L for the entire duration of follow-up (hazard ratio [HR] 1.66; 95% confidence interval [CI], 1.23 to 2.23, and HR 1.36, 95% CI 1.02 to 1.82, respectively) compared with participants who kept their bicarbonate 22 to 26 mmol/L, after adjusting for demographics, co-morbidities, medications including diuretics, eGFR, and proteinuria. Participants who maintained serum bicarbonate <22 mmol/L had almost a 2-fold increased risk of renal disease progression (HR 1.97; 95% CI, 1.50 to 2.57) compared with participants with bicarbonate 22 to 26 mmol/L. CONCLUSION: In this large CKD cohort, persistent serum bicarbonate >26 mmol/L was associated with increased risk of heart failure events and mortality. Further studies are needed to determine the optimal range of serum bicarbonate in CKD to prevent adverse clinical outcomes. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/25896890/Persistent_high_serum_bicarbonate_and_the_risk_of_heart_failure_in_patients_with_chronic_kidney_disease__CKD_:_A_report_from_the_Chronic_Renal_Insufficiency_Cohort__CRIC__study_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.114.001599?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -