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Serum bicarbonate and long-term outcomes in CKD
Vandana Menon1, Hocine Tighiouart, Nubia Smith Vaughn
1Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA. vandana.menon@gmail.com
Summary
Low serum bicarbonate levels in chronic kidney disease (CKD) patients are linked to worse outcomes, but this association disappears when considering kidney function (GFR). Further trials are needed to explore bicarbonate supplementation in CKD.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Research
Background:
- Low serum bicarbonate is common in chronic kidney disease (CKD).
- The impact of low serum bicarbonate on long-term outcomes in CKD patients remains unclear.
- This study investigates the association between serum bicarbonate levels and adverse outcomes in CKD.
Purpose of the Study:
- To examine the relationship between serum bicarbonate levels and long-term outcomes in patients with stage 2-4 CKD.
- To determine if this association is independent of kidney function and other clinical factors.
Main Methods:
- A cohort study utilizing data from the Modification of Diet in Renal Disease (MDRD) Study.
- Included 942 screened non-randomized and 839 randomized participants with stage 2-4 CKD and baseline serum bicarbonate measurements.
- Serum bicarbonate was categorized into quartiles; outcomes included kidney failure, all-cause mortality, and a composite outcome.
Main Results:
- Mean GFR was 39 mL/min/1.73 m(2) and mean serum bicarbonate was 23.3 mEq/L.
- Lower bicarbonate quartiles were associated with higher rates of kidney failure, mortality, and the composite outcome.
- These associations lost statistical significance after adjusting for baseline GFR.
Conclusions:
- Low serum bicarbonate is associated with increased risk of adverse outcomes in non-diabetic CKD patients.
- This risk is not independent of baseline GFR, suggesting GFR is a key mediating factor.
- Clinical trials are warranted to assess the efficacy of bicarbonate supplementation in slowing CKD progression.
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