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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 J+Am+Heart+Assoc
2015 ; 4
(4
): ä Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
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
#MMPMID25896890
Dobre M
; Yang W
; Pan Q
; Appel L
; Bellovich K
; Chen J
; Feldman H
; Fischer MJ
; Ham LL
; Hostetter T
; Jaar BG
; Kallem RR
; Rosas SE
; Scialla JJ
; Wolf M
; Rahman M
J Am Heart Assoc
2015[Apr]; 4
(4
): ä PMID25896890
show ga
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.