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. 2015 Apr 20;4(4):e001599.
doi: 10.1161/JAHA.114.001599.

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

Mirela Dobre  1 , Wei Yang  2 , Qiang Pan  2 , Lawrence Appel  3 , Keith Bellovich  4 , Jing Chen  5 , Harold Feldman  2 , Michael J Fischer  6 , L L Ham  5 , Thomas Hostetter  1 , Bernard G Jaar  3 , Radhakrishna R Kallem  7 , Sylvia E Rosas  8 , Julia J Scialla  9 , Myles Wolf  10 , Mahboob Rahman  11 ; CRIC Study Investigators
Collaborators, Affiliations

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

Mirela Dobre et al. J Am Heart Assoc. .

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.

Keywords: CKD; heart failure; serum bicarbonate.

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Figures

Figure 1.
Figure 1.
Distribution of mean serum bicarbonate in CRIC participants over their course of participation in the study. CRIC indicates Chronic Renal Insufficiency Cohort.
Figure 2.
Figure 2.
Percentage of follow‐up time spent with high, normal and low serum bicarbonate (N=3586 CRIC participants). CRIC indicates Chronic Renal Insufficiency Cohort.
Figure 3.
Figure 3.
Multivariable‐adjusted hazard ratios for time‐updated serum bicarbonate on heart failure (A) and renal events (B)* by subgroups in the CRIC Study using Marginal Structural Models. CRIC indicates Chronic Renal Insufficiency Cohort; eGFR, estimated glomerular filtration rate.
See this image and copyright information in PMC

Comment in

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