Lombardi Gianmarco, Chesnaye Nicholas C, Caskey Fergus J, Dekker Friedo W, Evans Marie, Heimburger Olof, Pippias Maria, Torino Claudia, Szymczak Maciej, Drechsler Christiane, Wanner Christoph, Gambaro Giovanni, Stel Vianda S, Jager Kitty J, Ferraro Pietro Manuel
Division of Nephrology, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.
Clin Kidney J. 2024 Aug 22;17(11):sfae254. doi: 10.1093/ckj/sfae254. eCollection 2024 Nov.
We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD) and during KRT.
Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality.
We included 1485 patients with a median follow-up of 2.9 (interquartile range 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population ( = .03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT ( = .01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk ( = .13). We observed effect modification by subjective global assessment category (-value for interaction = .02) and KRT (-value for interaction = .02).
A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.
我们旨在探讨在三个不同治疗阶段，即肾脏替代治疗（KRT）前阶段、KRT开始前后的过渡期（过渡期慢性肾脏病）以及KRT期间，血清碳酸氢盐（SBC）与晚期慢性肾脏病（CKD）患者死亡率之间的关系。
利用欧洲晚期CKD治疗质量研究（EQUAL）队列，该队列纳入了来自六个欧洲国家的年龄≥65岁且估算肾小球滤过率（eGFR）≤20 mL/min/1.73 m²的患者，我们使用多变量时间依赖性Cox回归模型，在三个独立的CKD人群（KRT前、过渡期CKD和KRT人群）中探讨纵向SBC与全因死亡率之间的关联。我们评估了预先指定的变量对SBC与死亡率之间关系的效应修正作用。
我们纳入了1485例患者，中位随访时间为2.9（四分位间距2.7）年，在此期间529例（35.6%）患者死亡。在KRT前人群中观察到SBC水平与全因死亡率之间呈U形关系（P = 0.03）。低累积暴露，定义为KRT开始前SBC轨迹下的面积，与过渡到KRT后死亡率风险增加相关（P = 0.01）。同样，在KRT人群中，低SBC水平显示出死亡率风险增加的趋势（P = 0.13）。我们观察到主观全面评定类别（交互作用P值 = 0.02）和KRT（交互作用P值 = 0.02）对效应有修正作用。
U形关系描述了晚期CKD KRT前人群中SBC与死亡率之间的关联，而在KRT人群中，低SBC水平观察到死亡率风险增加的趋势。
