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.
Abstract
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.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.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.
Type
Journal articleSubject
CRIC Study InvestigatorsHumans
Disease Progression
Bicarbonates
Diuretics
Glomerular Filtration Rate
Risk Factors
Longitudinal Studies
Middle Aged
Female
Male
Renal Insufficiency, Chronic
Heart Failure
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https://hdl.handle.net/10161/18485Published Version (Please cite this version)
10.1161/JAHA.114.001599Publication Info
Dobre, Mirela; Yang, Wei; Pan, Qiang; Appel, Lawrence; Bellovich, Keith; Chen, Jing;
... CRIC Study Investigators (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). 10.1161/JAHA.114.001599. Retrieved from https://hdl.handle.net/10161/18485.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Julia Jarrard Scialla
Adjunct Associate Professor in the Department of Medicine
Dr. Scialla is an Associate Professor of Medicine in Nephrology at Duke University
and a faculty member at the Duke Clinical Research Institute. Dr. Scialla trained
in Internal Medicine, Nephrology, and Clinical Epidemiology at the Johns Hopkins University
School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Her research
focuses on chronic kidney disease (CKD) epidemiology and prevention, with an emphasis
on the role of metabolic complications and nutri
Myles Selig Wolf
Charles Johnson, M.D. Distinguished Professor of Medicine
The focus of my research is disordered mineral metabolism across the spectrum of chronic
kidney disease, including dialysis, kidney transplantation and earlier stages.My research
has been published in leading general medicine and subspecialty journals, including
the New England Journal of Medicine, JAMA, the Journal of Clinical Investigation,
Circulation, Cell Metabolism, Journal of the American Society of Nephrolog
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