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

被引：72

作者：

Dobre, Mirela ^{[1
]}

Yang, Wei ^{[3
]}

Pan, Qiang ^{[3
]}

Appel, Lawrence ^{[4
,5
,6
]}

Bellovich, Keith ^{[7
]}

Chen, Jing ^{[8
]}

Feldman, Harold ^{[3
]}

Fischer, Michael J. ^{[9
,10
]}

Ham, L. L. ^{[8
]}

Hostetter, Thomas ^{[1
]}

Jaar, Bernard G. ^{[4
,5
,6
]}

Kallem, Radhakrishna R. ^{[11
]}

Rosas, Sylvia E. ^{[12
,13
]}

Scialla, Julia J. ^{[14
]}

Wolf, Myles ^{[15
]}

Rahman, Mahboob ^{[1
,2
]}

机构：

[1] Case Western Reserve Univ, Univ Hosp Case Med Ctr, Div Nephrol & Hypertens, Cleveland, OH 44106 USA

[2] Louis Stokes Cleveland VA Med Ctr, Cleveland, OH USA

[3] Univ Penn, Ctr Clin Epidemiol & Biostat, Perelman Sch Med, Philadelphia, PA 19104 USA

[4] Johns Hopkins Univ, Dept Med, Baltimore, MD USA

[5] Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA

[6] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA

[7] St John Hosp & Med Ctr Detroit, Detroit, MI USA

[8] Tulane Univ, Sch Med, Dept Med, Sect Nephrol & Hypertens, New Orleans, LA 70112 USA

[9] Jesse Brown VAMC, Chicago, IL USA

[10] Univ Illinois Hosp & Hlth Sci Syst, Chicago, IL USA

[11] Univ Penn, Perelman Sch Med, Dept Med, Renal Electrolyte & Hypertens Div, Philadelphia, PA 19104 USA

[12] Harvard Univ, Sch Med, Joslin Diabet Ctr, Boston, MA 02115 USA

[13] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Boston, MA 02215 USA

[14] Duke Univ, Sch Med, Durham, NC USA

[15] Northwestern Univ, Div Nephrol & Hypertens, Feinberg Sch Med, Chicago, IL 60611 USA

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2015年 / 4卷 / 04期

基金：

美国国家卫生研究院;

关键词：

CKD; heart failure; serum bicarbonate; GLOMERULAR-FILTRATION-RATE; MARGINAL STRUCTURAL MODELS; BASE-LINE CHARACTERISTICS; METABOLIC-ACIDOSIS; MORTALITY; ASSOCIATION; SURVIVAL; OUTCOMES; GFR; CALCIFICATION;

D O I：

10.1161/JAHA.114.001599

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：15

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