High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients

BMC Nephrology

Tatsuo Shiigai³  Renjiro Kuriyama²  Masayuki Yoshida¹  Masumi Ai¹  Eiichiro Kanda¹ 

[1] Tokyo Medical and Dental University, Bioethics Research Center, Yushima 1-5-45, Bunkyoku, Tokyo, 113-8519, Japan;Kokubunji Minamiguchi Clinic, Minamicho 3-15-6, Kokubunjishi, Tokyo, 185-0021, Japan;Shiigai Clinic, Shinmachi 2-6-4, Torideshi, Ibaraki, 302-0024, Japan

关键词: Acidosis;    CKD progression;    Elderly;    CKD;    Bicarbonate;   

Others  :  1083034
DOI  :  10.1186/1471-2369-14-4

 received in 2012-08-05, accepted in 2013-01-07,  发布年份 2013

【 摘 要 】

Background

Metabolic acidosis leads to chronic kidney disease (CKD) progression. The guidelines recommend a lower limit of serum bicarbonate level, but no upper limit. For serum bicarbonate level to be clinically useful as a therapeutic target marker, it is necessary to investigate the target serum bicarbonate level within the normal range to prevent CKD progression.

Methods

One hundred and thirteen elderly CKD patients, whose serum bicarbonate level was controlled within the normal range, were enrolled in this retrospective cohort study in Ibaraki, Japan. Outcome was defined as a decrease of 25% or more in estimated glomerular filtration rate (eGFR) or starting dialysis. We used Cox proportional hazard models adjusted for patients’ characteristics to examine the association between serum bicarbonate level and the outcome.

Results

Female patients were 36.3%: average age (SD), 70.4 (6.6) years; eGFR, 25.7 (13.6) ml/min/1.73 m²; serum bicarbonate level, 27.4 (3.2) mEq/l. Patients with the lowest quartile of serum bicarbonate levels [23.4 (1.8) mEq/l] showed a high risk of CKD progression compared with patients with high serum bicarbonate levels [28.8 (2.3) mEq/l]: adjusted hazard ratio (HR), 3.511 (95% CI, 1.342-9.186). A 1 mEq/l increase in serum bicarbonate level was associated with a low risk of CKD progression: adjusted HR, 0.791 [95% confidence interval (CI), 0.684-0.914].

Conclusions

In elderly CKD patients, our findings suggest that serum bicarbonate level is independently associated with CKD progression, and that a high serum bicarbonate level is associated with a low risk of CKD progression. A high target serum bicarbonate level within the normal range may be effective for preventing CKD progression.

【 授权许可】

   
2013 Kanda et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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