Association of serum bicarbonate levels with mortality in patients with non-dialysis-dependent CKD

Csaba P. Kovesdy, John E. Anderson, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Metabolic acidosis, usually manifested by low serum bicarbonate level, is common in chronic kidney disease (CKD) and appears to be associated with higher mortality in dialysis patients. It is not known whether a similar association is present in patients with non-dialysisdependent CKD (NDD-CKD). Methods. We used multivariable-adjusted Cox models to examine the association between baseline and time-variable serum bicarbonate (measured as total CO2) with the outcomes of all-cause mortality and the composite of predialysis mortality or end-stage renal disease in 1240 male patients with moderate and advanced NDD-CKD. Results. Serum bicarbonate showed a significant U-shaped association with all-cause mortality, with the highest mortality rate observed in patients with baseline serum bicarbonate levels <22 mmol/L [multivariable-adjusted hazard ratio (95% confidence interval) for patients with serum bicarbonate <22 mmol/L versus ≥22 mmol/L: 1.33 (1.05 1.69), P = 0.02] and the lowest mortality observed in patients with baseline serum bicarbonate of 2629 mmol/L. The associations between lower serum bicarbonate level and mortality were more accentuated in subgroups of patients with better nutritional status and lower inflammation. Conclusions. Both lower and higher serum bicarbonates are associated with increased all-cause mortality in patients with moderate and advanced NDD-CKD. Clinical trials are needed to determine if therapeutic interventions aimed at optimizing serum bicarbonate can result in improved outcomes in this population.

Original languageEnglish (US)
Pages (from-to)1232-1237
Number of pages6
JournalNephrology Dialysis Transplantation
Volume24
Issue number4
DOIs
StatePublished - Apr 2009

Keywords

  • Bicarbonate
  • Chronic kidney disease
  • Mortality

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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