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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Kidney+Dis
2014 ; 64
(4
): 542-9
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Serum bicarbonate concentrations and kidney disease progression in
community-living elders: the Health, Aging, and Body Composition (Health ABC)
Study
#MMPMID24953890
Goldenstein L
; Driver TH
; Fried LF
; Rifkin DE
; Patel KV
; Yenchek RH
; Harris TB
; Kritchevsky SB
; Newman AB
; Sarnak MJ
; Shlipak MG
; Ix JH
Am J Kidney Dis
2014[Oct]; 64
(4
): 542-9
PMID24953890
show ga
BACKGROUND: In populations with prevalent chronic kidney disease (CKD), lower
serum bicarbonate levels are associated with more rapid CKD progression, but
whether lower bicarbonate levels also are associated with risk of incident
estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) and CKD
progression among community-living persons with predominantly preserved kidney
function is unknown. STUDY DESIGN: Longitudinal observational cohort study.
SETTING & PARTICIPANTS: Well-functioning community-living elders aged 70-79 years
at inception. PREDICTOR: Serum bicarbonate level measured at the time of
collection by arterialized venous blood sample using an arterial blood gas
analyzer. OUTCOMES: Change in eGFR over 7 years, and new eGFR < 60 mL/min/1.73
m(2) with a rate of loss of at least 1 mL/min/1.73 m(2) per year. MEASUREMENTS:
Linear and logistic regressions were used to evaluate associations of baseline
serum bicarbonate level with change in eGFR and incident eGFR < 60 mL/min/1.73
m(2). RESULTS: At baseline, mean eGFR was 84 ± 16 (SD)mL/min/1.73 m(2), and serum
bicarbonate level was 25.2 ± 1.9 mmol/L. Compared with participants with higher
bicarbonate concentrations (23.0-28.0 mmol/L), those with bicarbonate
concentrations < 23 mmol/L (n = 85 [8%]) lost eGFR0.55 (95% CI, 0.13-0.97)
mL/min/1.73 m(2) per year faster in models adjusted for demographics, CKD risk
factors, baseline eGFR, and urine albumin-creatinine ratio. Among the 989 (92%)
participants with baseline eGFRs > 60 mL/min/1.73 m(2), 252 (25%) developed
incident eGFRs < 60 mL/min/1.73 m(2) at follow-up. Adjusting for the same
covariates, participants with bicarbonate concentrations < 23 mmol/L had nearly
2-fold greater odds of incident eGFRs < 60 mL/min/1.73 m(2) (OR, 1.72; 95% CI,
0.97-3.07) compared with those with higher bicarbonate concentrations.
LIMITATIONS: Only 2 measurements of kidney function separated by 7 years and loss
to follow-up due to intervening mortality in this elderly population.
CONCLUSIONS: Lower serum bicarbonate concentrations are associated independently
with decline in eGFR and incident eGFR < 60 mL/min/1.73 m(2) in community-living
older persons. If confirmed, serum bicarbonate levels may give insight into
kidney tubule health in persons with preserved eGFRs and suggest a possible new
target for intervention to prevent CKD development.