Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: A report from the Chronic Renal Insufficiency Cohort (CRIC) study

Mirela Dobre, Wei Yang, Jing Chen, Paul Drawz, L. Lee Hamm, Edward Horwitz, Thomas Hostetter, Bernard Jaar, Claudia M. Lora, Lisa Nessel, Akinlolu Ojo, Julia Scialla, Susan Steigerwalt, Valerie Teal, Myles Wolf, Mahboob Rahman

Research output: Contribution to journalArticle

95 Citations (Scopus)

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 m2, 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 m2 (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.

Original languageEnglish
Pages (from-to)670-678
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number4
DOIs
StatePublished - Oct 1 2013

Fingerprint

Bicarbonates
Chronic Renal Insufficiency
Cohort Studies
Kidney
Serum
Heart Failure
Glomerular Filtration Rate
Mortality
Sodium Bicarbonate
Peripheral Arterial Disease
Kidney Diseases
Kidney Transplantation
Chronic Kidney Failure
Observational Studies
Disease Progression
Dialysis
Stroke
Myocardial Infarction

Keywords

  • cardiovascular morbidity
  • chronic kidney disease
  • Metabolic acidosis
  • serum bicarbonate

ASJC Scopus subject areas

  • Nephrology

Cite this

Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD : A report from the Chronic Renal Insufficiency Cohort (CRIC) study. / Dobre, Mirela; Yang, Wei; Chen, Jing; Drawz, Paul; Hamm, L. Lee; Horwitz, Edward; Hostetter, Thomas; Jaar, Bernard; Lora, Claudia M.; Nessel, Lisa; Ojo, Akinlolu; Scialla, Julia; Steigerwalt, Susan; Teal, Valerie; Wolf, Myles; Rahman, Mahboob.

In: American Journal of Kidney Diseases, Vol. 62, No. 4, 01.10.2013, p. 670-678.

Research output: Contribution to journalArticle

Dobre, M, Yang, W, Chen, J, Drawz, P, Hamm, LL, Horwitz, E, Hostetter, T, Jaar, B, Lora, CM, 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, vol. 62, no. 4, pp. 670-678. https://doi.org/10.1053/j.ajkd.2013.01.017
Dobre, Mirela ; Yang, Wei ; Chen, Jing ; Drawz, Paul ; Hamm, L. Lee ; Horwitz, Edward ; Hostetter, Thomas ; Jaar, Bernard ; Lora, Claudia M. ; Nessel, Lisa ; Ojo, Akinlolu ; Scialla, Julia ; Steigerwalt, Susan ; Teal, Valerie ; Wolf, Myles ; Rahman, Mahboob. / Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD : A report from the Chronic Renal Insufficiency Cohort (CRIC) study. In: American Journal of Kidney Diseases. 2013 ; Vol. 62, No. 4. pp. 670-678.
@article{9d75644dc10144e1844157a3694cf003,
title = "Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: A report from the Chronic Renal Insufficiency Cohort (CRIC) study",
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 m2, 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 m2 (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.",
keywords = "cardiovascular morbidity, chronic kidney disease, Metabolic acidosis, serum bicarbonate",
author = "Mirela Dobre and Wei Yang and Jing Chen and Paul Drawz and Hamm, {L. Lee} and Edward Horwitz and Thomas Hostetter and Bernard Jaar and Lora, {Claudia M.} and Lisa Nessel and Akinlolu Ojo and Julia Scialla and Susan Steigerwalt and Valerie Teal and Myles Wolf and Mahboob Rahman",
year = "2013",
month = "10",
day = "1",
doi = "10.1053/j.ajkd.2013.01.017",
language = "English",
volume = "62",
pages = "670--678",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD

T2 - 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

PY - 2013/10/1

Y1 - 2013/10/1

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 m2, 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 m2 (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.

AB - 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 m2, 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 m2 (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.

KW - cardiovascular morbidity

KW - chronic kidney disease

KW - Metabolic acidosis

KW - serum bicarbonate

UR - http://www.scopus.com/inward/record.url?scp=84884534769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884534769&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2013.01.017

DO - 10.1053/j.ajkd.2013.01.017

M3 - Article

C2 - 23489677

AN - SCOPUS:84884534769

VL - 62

SP - 670

EP - 678

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -