Case Western Reserve University, Cleveland, OH; Division of Nephrology and Hypertension, University Hospital Case Medical Center, Cleveland, OH; Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
Am J Kidney Dis. 2013 Oct;62(4):670-8. doi: 10.1053/j.ajkd.2013.01.017. Epub 2013 Mar 13.
The purpose of this study is to evaluate serum bicarbonate level as a risk factor for renal outcomes, cardiovascular events, and mortality in patients with chronic kidney disease (CKD).
Observational cohort study.
SETTING & PARTICIPANTS: 3,939 participants with CKD stages 2-4 who enrolled in the Chronic Renal Insufficiency Cohort (CRIC) between June 2003 and December 2008.
Serum bicarbonate level.
Renal outcomes, defined as end-stage renal disease (either initiation of dialysis therapy or kidney transplantation) or 50% reduction in estimated glomerular filtration rate (eGFR); atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease); congestive heart failure events; and death.
Time to event.
Mean eGFR was 44.8 ± 16.8 (SD) mL/min/1.73 m(2), and median serum bicarbonate level was 24 (IQR, 22-26) mEq/L. During a median follow-up of 3.9 years, 374 participants died, 767 had a renal outcome, 332 experienced an atherosclerotic event, and 391 had a congestive heart failure event. In adjusted analyses, the risk of developing a renal end point was 3% lower per 1-mEq/L increase in serum bicarbonate level (HR, 0.97; 95% CI, 0.94-0.99; P = 0.01). The association was stronger for participants with eGFR >45 mL/min/1.73 m(2) (HR, 0.91; 95% CI, 0.85-0.97; P = 0.004). The risk of heart failure increased by 14% (HR, 1.14; 95% CI, 1.03-1.26; P = 0.02) per 1-mEq/L increase in serum bicarbonate level over 24 mEq/L. Serum bicarbonate level was not associated independently with atherosclerotic events (HR, 0.99; 95% CI, 0.95-1.03; P = 0.6) and all-cause mortality (HR, 0.98; 95% CI, 0.95-1.02; P = 0.3).
Single measurement of sodium bicarbonate.
In a cohort of participants with CKD, low serum bicarbonate level was an independent risk factor for kidney disease progression, particularly for participants with preserved kidney function. The risk of heart failure was higher at the upper extreme of serum bicarbonate levels. There was no association between serum bicarbonate level and all-cause mortality or atherosclerotic events.
本研究旨在评估血清碳酸氢盐水平作为慢性肾脏病（CKD）患者发生肾脏结局、心血管事件和死亡的风险因素。
观察性队列研究。
2003 年 6 月至 2008 年 12 月期间，3939 名 CKD 2-4 期患者参加了慢性肾功能不全队列（CRIC）。
血清碳酸氢盐水平。
肾脏结局，定义为终末期肾病（开始透析治疗或肾移植）或估算肾小球滤过率（eGFR）降低 50%；动脉粥样硬化事件（心肌梗死、中风或外周动脉疾病）；充血性心力衰竭事件；以及死亡。
事件时间。
平均 eGFR 为 44.8 ± 16.8（SD）mL/min/1.73 m2，中位数血清碳酸氢盐水平为 24（IQR，22-26）mEq/L。在中位随访 3.9 年期间，374 名患者死亡，767 名患者发生肾脏结局，332 名患者发生动脉粥样硬化事件，391 名患者发生充血性心力衰竭事件。在调整分析中，血清碳酸氢盐水平每增加 1 mEq/L，发生肾脏终点的风险降低 3%（HR，0.97；95%CI，0.94-0.99；P=0.01）。对于 eGFR>45 mL/min/1.73 m2 的患者，这种关联更强（HR，0.91；95%CI，0.85-0.97；P=0.004）。血清碳酸氢盐水平每升高 1 mEq/L，超过 24 mEq/L，心力衰竭的风险增加 14%（HR，1.14；95%CI，1.03-1.26；P=0.02）。血清碳酸氢盐水平与动脉粥样硬化事件（HR，0.99；95%CI，0.95-1.03；P=0.6）和全因死亡率（HR，0.98；95%CI，0.95-1.02；P=0.3）无独立关联。
血清碳酸氢盐的单次测量。
在 CKD 患者队列中，低血清碳酸氢盐水平是肾脏疾病进展的独立危险因素，特别是对肾功能正常的患者。血清碳酸氢盐水平处于较高水平时，心力衰竭的风险更高。血清碳酸氢盐水平与全因死亡率或动脉粥样硬化事件之间无关联。
