Fukasawa H, Kaneko M, Uchiyama Y, Yasuda H, Furuya R. Lower bicarbonate level is associated with CKD progression and all-cause mortality: a propensity score matching analysis.
BMC Nephrol 2022;
23:86. [PMID:
35246054 PMCID:
PMC8895620 DOI:
10.1186/s12882-022-02712-y]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Although metabolic acidosis is known as a potential complication of chronic kidney disease (CKD), there is limited information concerning the association between metabolic acidosis and clinical outcomes.
Methods
Five hundred fifty-two patients referred to renal division of Iwata City Hospital from 2015 to 2017 were included as a retrospective CKD cohort, and finally 178 patients with CKD stage III or IV and 20 to 80 years of age were analyzed. We examined the association between serum bicarbonate (HCO3−) levels and clinical outcomes using Kaplan-Meier methods after the matching of baseline characteristics by propensity scores.
Results
Of 178 patients with CKD, patients with lower HCO3− levels (N = 94), as compared with patients with higher HCO3− levels (N = 84), were more likely to be male (P < 0.05), had more severe CKD stages (P < 0.05), more frequent use of renin-angiotensin system inhibitor (P < 0.05) or uric acid lowering agent (P < 0.001), heavier body weight (P < 0.001) and lower estimated glomerular filtration rate (P < 0.05). In Kaplan-Meier analysis after propensity score matching, the incidence of composite outcome as the doubling of serum creatinine level from baseline, end-stage kidney disease requiring the initiation of dialysis, or death from any causes was significantly fewer in the higher HCO3− group than the lower HCO3− group (N = 57 each group, P = 0.016).
Conclusions
Lower HCO3− level is significantly associated with the doubling of serum creatinine level, end-stage kidney disease or all-cause mortality in patients with CKD.
Trial registration
This study was registered with the Clinical Trial Registry of the University Hospital Medical Information Network (http://www.umin.ac.jp/, study number: UMIN000044861).
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