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Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort StudyDobre M.a · Roy J.c · Tao K.c · Anderson A.H.c · Bansal N.e · Chen J.f · Deo R.d · Drawz P.g · Feldman H.I.c · Hamm L.L.f · Hostetter T.a · Kusek J.W.h · Lora C.i · Ojo A.O.j · Shrama K.k · Rahman M.a, b · the CRIC Study Investigators
aDivision of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, and bLouis Stokes Cleveland VA Medical Center, Cleveland, Ohio., cCenter for Clinical Epidemiology and Biostatistics and dCardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa., eDivision of Nephrology, Kidney Research Institute, University of Washington, Seattle, Wash., fSection of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, La., gDivision of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minn., hNIDDK, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, iDepartment of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Ill., jDepartment of Medicine - Nephrology, University of Michigan, Ann Arbor, Mich., and kCenter for Renal Translational Medicine, Division of Nephrology-Hypertension, University of California at San Diego, San Diego, Calif., USA
Background: Heart failure (HF) is a frequent occurrence in chronic kidney disease (CKD) patients and predicts poor survival. Serum bicarbonate is associated with increased rates of HF in CKD; however, the mechanisms leading to this association are incompletely understood. This study aims to assess whether serum bicarbonate is independently associated with structural and functional cardiac abnormalities in CKD. Methods: The association between serum bicarbonate and left ventricular (LV) hypertrophy (LVH), LV mass indexed to height2.7, LV geometry, ejection fraction (EF) and diastolic dysfunction was assessed in 3,483 participants without NYHA class III/IV HF, enrolled in the Chronic Renal Insufficiency Cohort study. Results: The mean estimated glomerular filtration rate was 42.5 ± 17 ml/min/1.73 m2. The overall prevalence of LVH was 51.2%, with 57.8, 50.9 and 47.7% for bicarbonate categories <22, 22-26 and >26 mmol/l, respectively. Participants with low bicarbonate were more likely to have LVH and abnormal LV geometry (OR 1.32; 95% CI 1.07-1.64, and OR 1.57; 95% CI 1.14-2.16, respectively). However, the association was not statistically significant after adjustment for demographics, traditional cardiovascular risk factors, medications and kidney function (OR 1.07; 95% CI 0.66-1.72, and OR 1.27; 95% CI 0.64-2.51, respectively). No association was found between bicarbonate and systolic or diastolic dysfunction. During follow-up, no significant changes in LV mass or EF were observed in any bicarbonate strata. Conclusions: In a large CKD study, serum bicarbonate was associated with LV mass and concentric LVH; however, this association was attenuated after adjustment for clinical factors suggesting that the observed cardiac effects are mediated through yet unknown mechanisms.
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