Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016;43(6):411-20.
doi: 10.1159/000446860. Epub 2016 May 28.

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

Mirela Dobre  1 , Jason Roy, Kaixiang Tao, Amanda H Anderson, Nisha Bansal, Jing Chen, Rajat Deo, Paul Drawz, Harold I Feldman, L Lee Hamm, Thomas Hostetter, John W Kusek, Claudia Lora, Akinlolu O Ojo, Kumar Shrama, Mahboob Rahman; CRIC Study Investigators
Affiliations

Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

Mirela Dobre et al. Am J Nephrol. 2016.

Abstract

Background: Heart failure (HF) is a frequent occurrence in chronic kidney disease (CKD) patients and predicts poor survival. Serum bicarbonate is associated with increased rates of HF in CKD; however, the mechanisms leading to this association are incompletely understood. This study aims to assess whether serum bicarbonate is independently associated with structural and functional cardiac abnormalities in CKD.

Methods: The association between serum bicarbonate and left ventricular (LV) hypertrophy (LVH), LV mass indexed to height2.7, LV geometry, ejection fraction (EF) and diastolic dysfunction was assessed in 3,483 participants without NYHA class III/IV HF, enrolled in the Chronic Renal Insufficiency Cohort study.

Results: The mean estimated glomerular filtration rate was 42.5 ± 17 ml/min/1.73 m2. The overall prevalence of LVH was 51.2%, with 57.8, 50.9 and 47.7% for bicarbonate categories <22, 22-26 and >26 mmol/l, respectively. Participants with low bicarbonate were more likely to have LVH and abnormal LV geometry (OR 1.32; 95% CI 1.07-1.64, and OR 1.57; 95% CI 1.14-2.16, respectively). However, the association was not statistically significant after adjustment for demographics, traditional cardiovascular risk factors, medications and kidney function (OR 1.07; 95% CI 0.66-1.72, and OR 1.27; 95% CI 0.64-2.51, respectively). No association was found between bicarbonate and systolic or diastolic dysfunction. During follow-up, no significant changes in LV mass or EF were observed in any bicarbonate strata.

Conclusions: In a large CKD study, serum bicarbonate was associated with LV mass and concentric LVH; however, this association was attenuated after adjustment for clinical factors suggesting that the observed cardiac effects are mediated through yet unknown mechanisms.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean LV mass (g/m2.7) by serum bicarbonate categories
Figure 2
Figure 2
Association between serum bicarbonate level (mmol/L) and left ventricular mass indexed to height at 2.7 (g/m2.7). Adjusted restricted cubic spline model with knots at 20, 24 and 28. The solid line represents the effect. (p=0.13)
Figure 3
Figure 3
Left ventricular geometry by the levels of serum bicarbonate
See this image and copyright information in PMC

References

    1. Kraut JA, Kurtz I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. Am J Kidney Dis. 2005;45:978–93. - PubMed
    1. Bailey JL. Metabolic acidosis: an unrecognized cause of morbidity in the patient with chronic kidney disease. Kidney Int Suppl. 2005:S15–23. - PubMed
    1. Schwartz WB, Hall PW, 3rd, Hays RM, Relman AS. On the mechanism of acidosis in chronic renal disease. JCI. 1959;38:39–52. - PMC - PubMed
    1. Relman AS. Renal Acidosis and Renal Excretion of Acid in Health and Disease. Adv Int Med. 1964;12:295–347. - PubMed
    1. Herzog CA, Asinger RW, Berger AK, Charytan DM, Diez J, Hart RG, Eckardt KU, Kasiske BL, McCullough PA, Passman RS, DeLoach SS, Pun PH, Ritz E. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011;80:572–86. - PubMed

Publication types