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Low Serum Bicarbonate and CKD Progression in Children.
Clin J Am Soc Nephrol. 2020 06 08; 15(6):755-765.CJ

Abstract

BACKGROUND AND OBJECTIVES

Studies of adults have demonstrated an association between metabolic acidosis, as measured by low serum bicarbonate levels, and CKD progression. We evaluated this relationship in children using data from the Chronic Kidney Disease in Children study.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The relationship between serum bicarbonate and a composite end point, defined as 50% decline in eGFR or KRT, was described using parametric and semiparametric survival methods. Analyses were stratified by underlying nonglomerular and glomerular diagnoses, and adjusted for demographic characteristics, eGFR, proteinuria, anemia, phosphate, hypertension, and alkali therapy.

RESULTS

Six hundred and three participants with nonglomerular disease contributed 2673 person-years of follow-up, and 255 with a glomerular diagnosis contributed 808 person-years of follow-up. At baseline, 39% (237 of 603) of participants with nonglomerular disease had a bicarbonate level of ≤22 meq/L and 36% (85 of 237) of those participants reported alkali therapy treatment. In participants with glomerular disease, 31% (79 of 255) had a bicarbonate of ≤22 meq/L, 18% (14 of 79) of those participants reported alkali therapy treatment. In adjusted longitudinal analyses, compared with participants with a bicarbonate level >22 meq/L, hazard ratios associated with a bicarbonate level of <18 meq/L and 19-22 meq/L were 1.28 [95% confidence interval (95% CI), 0.84 to 1.94] and 0.91 (95% CI, 0.65 to 1.26), respectively, in children with nonglomerular disease. In children with glomerular disease, adjusted hazard ratios associated with bicarbonate level ≤18 meq/L and bicarbonate 19-22 meq/L were 2.16 (95% CI, 1.05 to 4.44) and 1.74 (95% CI, 1.07 to 2.85), respectively. Resolution of low bicarbonate was associated with a lower risk of CKD progression compared with persistently low bicarbonate (≤22 meq/L).

CONCLUSIONS

In children with glomerular disease, low bicarbonate was linked to a higher risk of CKD progression. Resolution of low bicarbonate was associated with a lower risk of CKD progression. Fewer than one half of all children with low bicarbonate reported treatment with alkali therapy. Long-term studies of alkali therapy's effect in patients with pediatric CKD are needed.

Authors+Show Affiliations

Division of Pediatric Nephrology, Children's National Hospital, Washington, DC ddbrown@childrensnational.org.Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland ddbrown@childrensnational.org.Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, New York.Division of Pediatric Nephrology, Weill Cornell Medicine, New York, New York.Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California.Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Division of Pediatric Nephrology, University of Rochester, Rochester, New York.Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri.Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, New York.Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.

Pub Type(s)

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

Language

eng

PubMed ID

32467307

Citation

Brown, Denver D., et al. "Low Serum Bicarbonate and CKD Progression in Children." Clinical Journal of the American Society of Nephrology : CJASN, vol. 15, no. 6, 2020, pp. 755-765.
Brown DD, Roem J, Ng DK, et al. Low Serum Bicarbonate and CKD Progression in Children. Clin J Am Soc Nephrol. 2020;15(6):755-765.
Brown, D. D., Roem, J., Ng, D. K., Reidy, K. J., Kumar, J., Abramowitz, M. K., Mak, R. H., Furth, S. L., Schwartz, G. J., Warady, B. A., Kaskel, F. J., & Melamed, M. L. (2020). Low Serum Bicarbonate and CKD Progression in Children. Clinical Journal of the American Society of Nephrology : CJASN, 15(6), 755-765. https://doi.org/10.2215/CJN.07060619
Brown DD, et al. Low Serum Bicarbonate and CKD Progression in Children. Clin J Am Soc Nephrol. 2020 06 8;15(6):755-765. PubMed PMID: 32467307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low Serum Bicarbonate and CKD Progression in Children. AU - Brown,Denver D, AU - Roem,Jennifer, AU - Ng,Derek K, AU - Reidy,Kimberly J, AU - Kumar,Juhi, AU - Abramowitz,Matthew K, AU - Mak,Robert H, AU - Furth,Susan L, AU - Schwartz,George J, AU - Warady,Bradley A, AU - Kaskel,Frederick J, AU - Melamed,Michal L, Y1 - 2020/05/28/ PY - 2019/06/14/received PY - 2020/04/09/accepted PY - 2020/5/30/pubmed PY - 2020/5/30/medline PY - 2020/5/30/entrez KW - acidosis KW - alkalis KW - anemia KW - bicarbonates KW - chronic KW - chronic kidney disease KW - chronic metabolic acidosis KW - demography KW - glomerular filtration rate KW - hypertension KW - longitudinal studies KW - pediatrics KW - phosphates KW - proteinuria KW - renal insufficiency KW - renal progression KW - renal replacement therapy SP - 755 EP - 765 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 15 IS - 6 N2 - BACKGROUND AND OBJECTIVES: Studies of adults have demonstrated an association between metabolic acidosis, as measured by low serum bicarbonate levels, and CKD progression. We evaluated this relationship in children using data from the Chronic Kidney Disease in Children study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The relationship between serum bicarbonate and a composite end point, defined as 50% decline in eGFR or KRT, was described using parametric and semiparametric survival methods. Analyses were stratified by underlying nonglomerular and glomerular diagnoses, and adjusted for demographic characteristics, eGFR, proteinuria, anemia, phosphate, hypertension, and alkali therapy. RESULTS: Six hundred and three participants with nonglomerular disease contributed 2673 person-years of follow-up, and 255 with a glomerular diagnosis contributed 808 person-years of follow-up. At baseline, 39% (237 of 603) of participants with nonglomerular disease had a bicarbonate level of ≤22 meq/L and 36% (85 of 237) of those participants reported alkali therapy treatment. In participants with glomerular disease, 31% (79 of 255) had a bicarbonate of ≤22 meq/L, 18% (14 of 79) of those participants reported alkali therapy treatment. In adjusted longitudinal analyses, compared with participants with a bicarbonate level >22 meq/L, hazard ratios associated with a bicarbonate level of <18 meq/L and 19-22 meq/L were 1.28 [95% confidence interval (95% CI), 0.84 to 1.94] and 0.91 (95% CI, 0.65 to 1.26), respectively, in children with nonglomerular disease. In children with glomerular disease, adjusted hazard ratios associated with bicarbonate level ≤18 meq/L and bicarbonate 19-22 meq/L were 2.16 (95% CI, 1.05 to 4.44) and 1.74 (95% CI, 1.07 to 2.85), respectively. Resolution of low bicarbonate was associated with a lower risk of CKD progression compared with persistently low bicarbonate (≤22 meq/L). CONCLUSIONS: In children with glomerular disease, low bicarbonate was linked to a higher risk of CKD progression. Resolution of low bicarbonate was associated with a lower risk of CKD progression. Fewer than one half of all children with low bicarbonate reported treatment with alkali therapy. Long-term studies of alkali therapy's effect in patients with pediatric CKD are needed. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/32467307/Low_Serum_Bicarbonate_and_CKD_Progression_in_Children_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=32467307 DB - PRIME DP - Unbound Medicine ER -