Association between Serum Bicarbonate and Death in Hemodialysis Patients

Wu, Dennis Y.; Shinaberger, Christian S.; Regidor, Deborah L.; McAllister, Charles J.; Kopple, Joel D.; Kalantar-Zadeh, Kamyar

doi:10.2215/cjn.00010505

Cited by 144 publications

(99 citation statements)

References 49 publications

(18 reference statements)

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“…Both low (<17 mEq/l) and high (>23 mEq/l) bicarbonate levels were associated with increased death risk [11]. Data from the DOPPS study reported similar results.…”

Section: Discussionmentioning

confidence: 89%

“…The relationship between acidosis and mortality in dialysis has been investigated in a large cohort of chronic HD patients [11]. Both low (<17 mEq/l) and high (>23 mEq/l) bicarbonate levels were associated with increased death risk [11].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of metabolic acidosis (serum HCO 3 - <20 mEq/l) among chronic HD patients is close to 25% [11]. Some of the undesirable effects of acidosis include negative nitrogen balance and muscle wasting, protein catabolism, increased corticosteroid and parathyroid hormone (PTH) production [12,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Cytokine Secretion and Markers of Inflammation in Relation to Acidosis among Chronic Hemodialysis Patients

Ori

Bergman²,

Bessler

et al. 2013

Blood Purif

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Background: Various cytokines are increased in hemodialysis (HD) patients, and are considered prognostic markers. Metabolic acidosis is common among chronic HD patients and is associated with survival. The relationship between acidosis and cytokines in HD patients has not been fully explored. The study aim was to measure pro- and anti-inflammatory cytokines in HD patients, with relation to bicarbonate levels. Methods: Forty-seven stable HD patients were included (male/female 28/19, mean age 70.4 ± 14.5 years). Blood tests were taken before a midweek dialysis session. Cytokine secretion from peripheral blood mononuclear cells was measured. Results: Acidosis versus no acidosis (serum HCO₃^- 21.5 ± 0.2 vs. 24.9 ± 0.3 mEq/l, p < 0.001) was associated with decreased secretion of the anti-inflammatory interleukin-10 (IL-10, 1.16 ± 0.11 vs. 1.71 ± 0.20 ng/ml, p = 0.023). Patients with acidosis had higher parathyroid hormone (PTH), calcium-phosphate product, protein intake and transferrin. Higher IL-10 was associated with increased IL-6 secretion, higher bicarbonate, younger age and lower PTH. Conclusions: In stable chronic HD patients, a possible direct relation exists between metabolic acidosis and IL-10.

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“…Both low (<17 mEq/l) and high (>23 mEq/l) bicarbonate levels were associated with increased death risk [11]. Data from the DOPPS study reported similar results.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cytokine Secretion and Markers of Inflammation in Relation to Acidosis among Chronic Hemodialysis Patients

Ori

Bergman²,

Bessler

et al. 2013

Blood Purif

View full text Add to dashboard Cite

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“…The association of all-cause mortality with serum bicarbonate was U shaped, with higher serum bicarbonate level also being associated with worse prognosis in CKD patients [13,16]. The nonlinear (U shaped) association of serum bicarbonate level with gait speed and quadriceps peak torque was also observed in the general population 50 years or older [37].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have demonstrated that a serum bicarbonate concentration lower than 22 mmol/l is associated with an increased risk of total death in dialysis [13,14] and nondialysis CKD patients [15,16]. The Kidney Disease Improving Global Outcomes (KDIGO) suggests that oral bicarbonate supplementation should be given to maintain serum bicarbonate within the normal range in CKD patients with serum bicarbonate <22 mmol/l [17].…”

Section: Introductionmentioning

confidence: 99%

Association of Serum Bicarbonate with Bone Fractures in Hemodialysis Patients: The Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D)

et al. 2014

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Background/Aims: Bone fracture is often complicated in hemodialysis (HD) patients. Metabolic acidosis is related to bone disease and muscle wasting, but it is not known whether acid-base disturbance is associated with the risk of bone fractures. The aim of this study was to clarify the association of serum bicarbonate level with bone fracture in HD patients. Methods: Using a subcohort of the Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D), 890 prevalent HD patients (age: 62 years old, male: 62.8%, duration of dialysis: 8.3 years) with secondary hyperparathyroidism were studied. After measuring predialysis serum bicarbonate at a 2-day interdialytic interval, we prospectively followed them every 3 months, and examined the occurrence of any type of bone fracture or hospitalization due to fracture over a 3-year observation period. Results: Seventy-four bone fractures and 47 hospitalizations due to fracture were observed during the follow-up period. HD patients with serum bicarbonate <20 mmol/l had a 1.93 (95% CI 1.01-3.71)-fold higher risk for all-cause fractures than those with serum bicarbonate of 20.0-21.9 mmol/l. A higher bicarbonate level (≥22 mmol/l) was also related to an increased risk of bone fracture. A restricted cubic regression spline disclosed that the higher or the lower than 21.0 mmol/l of serum bicarbonate, the greater the risk for bone fracture. Conclusion: Both a lower level and a higher level of predialysis bicarbonate concentration were associated with risk of bone fracture in HD patients with secondary hyperparathyroidism.

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