Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients

Tae Ik Chang, Ea Wha Kang, Hyung Woo Kim, Geun Woo Ryu, Cheol Ho Park, Jung Tak Park, Tae Hyun Yoo, Sug Kyun Shin, Shin Wook Kang, Kyu Hun Choi, Dae Suk Han, Seung Hyeok Han, Jingyun Yang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Low residual renal function (RRF) and serum bicarbonate are associated with adverse outcomes in peritoneal dialysis (PD) patients. However, a relationship between the 2 has not yet been determined in these patients. Therefore, this study aimed to investigate whether low serum bicarbonate has a deteriorating effect on RRF in PD patients. This prospective observational study included a total of 405 incident patients who started PD between January 2000 and December 2005. We determined risk factors for complete loss of RRF using competing risk methods and evaluated the effects of time-averaged serum bicarbonate (TA-Bic) on the decline of RRF over the first 3 years of dialysis treatment using generalized linear mixed models. During the first 3 years of dialysis, 95 (23.5%) patients became anuric. The mean time until patients became anuric was 20.8±9.0 months. After adjusting for multiple potentially confounding covariates, an increase in TA-Bic level was associated with a significantly decreased risk of loss of RRF (hazard ratio per 1 mEq/L increase, 0.84; 0.75-0.93; P = 0.002), and in comparison to TA-Bic ≥ 24 mEq/L, TA-Bic < 24 mEq/L conferred a 2.62-fold higher risk of becoming anuric. Furthermore, the rate of RRF decline estimated by generalized linear mixed models was significantly greater in patients with TA-Bic < 24 mEq/L compared with those with TA-Bic ≥ 24 mEq/L (-0.16 vs-0.11mL/min/mo/1.73m2, P< 0.001). In this study, a clear association was found between low serum bicarbonate and loss of RRF in PD patients. Nevertheless, whether correction of metabolic acidosis for this indication provides additional protection for preserving RRF in these patients is unknown. Future interventional studies should more appropriately address this question.

Original languageEnglish
Article numbere1276
JournalMedicine (United States)
Volume94
Issue number31
DOIs
Publication statusPublished - 2015 Aug 1

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Peritoneal Dialysis
Bicarbonates
Kidney
Serum
Dialysis
Linear Models
Acidosis
Observational Studies
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chang, T. I., Kang, E. W., Kim, H. W., Ryu, G. W., Park, C. H., Park, J. T., ... Yang, J. (2015). Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients. Medicine (United States), 94(31), [e1276]. https://doi.org/10.1097/MD.0000000000001276
Chang, Tae Ik ; Kang, Ea Wha ; Kim, Hyung Woo ; Ryu, Geun Woo ; Park, Cheol Ho ; Park, Jung Tak ; Yoo, Tae Hyun ; Shin, Sug Kyun ; Kang, Shin Wook ; Choi, Kyu Hun ; Han, Dae Suk ; Han, Seung Hyeok ; Yang, Jingyun. / Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients. In: Medicine (United States). 2015 ; Vol. 94, No. 31.
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abstract = "Low residual renal function (RRF) and serum bicarbonate are associated with adverse outcomes in peritoneal dialysis (PD) patients. However, a relationship between the 2 has not yet been determined in these patients. Therefore, this study aimed to investigate whether low serum bicarbonate has a deteriorating effect on RRF in PD patients. This prospective observational study included a total of 405 incident patients who started PD between January 2000 and December 2005. We determined risk factors for complete loss of RRF using competing risk methods and evaluated the effects of time-averaged serum bicarbonate (TA-Bic) on the decline of RRF over the first 3 years of dialysis treatment using generalized linear mixed models. During the first 3 years of dialysis, 95 (23.5{\%}) patients became anuric. The mean time until patients became anuric was 20.8±9.0 months. After adjusting for multiple potentially confounding covariates, an increase in TA-Bic level was associated with a significantly decreased risk of loss of RRF (hazard ratio per 1 mEq/L increase, 0.84; 0.75-0.93; P = 0.002), and in comparison to TA-Bic ≥ 24 mEq/L, TA-Bic < 24 mEq/L conferred a 2.62-fold higher risk of becoming anuric. Furthermore, the rate of RRF decline estimated by generalized linear mixed models was significantly greater in patients with TA-Bic < 24 mEq/L compared with those with TA-Bic ≥ 24 mEq/L (-0.16 vs-0.11mL/min/mo/1.73m2, P< 0.001). In this study, a clear association was found between low serum bicarbonate and loss of RRF in PD patients. Nevertheless, whether correction of metabolic acidosis for this indication provides additional protection for preserving RRF in these patients is unknown. Future interventional studies should more appropriately address this question.",
author = "Chang, {Tae Ik} and Kang, {Ea Wha} and Kim, {Hyung Woo} and Ryu, {Geun Woo} and Park, {Cheol Ho} and Park, {Jung Tak} and Yoo, {Tae Hyun} and Shin, {Sug Kyun} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Han, {Dae Suk} and Han, {Seung Hyeok} and Jingyun Yang",
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Chang, TI, Kang, EW, Kim, HW, Ryu, GW, Park, CH, Park, JT, Yoo, TH, Shin, SK, Kang, SW, Choi, KH, Han, DS, Han, SH & Yang, J 2015, 'Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients', Medicine (United States), vol. 94, no. 31, e1276. https://doi.org/10.1097/MD.0000000000001276

Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients. / Chang, Tae Ik; Kang, Ea Wha; Kim, Hyung Woo; Ryu, Geun Woo; Park, Cheol Ho; Park, Jung Tak; Yoo, Tae Hyun; Shin, Sug Kyun; Kang, Shin Wook; Choi, Kyu Hun; Han, Dae Suk; Han, Seung Hyeok; Yang, Jingyun.

In: Medicine (United States), Vol. 94, No. 31, e1276, 01.08.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low serum bicarbonate predicts residual renal function loss in peritoneal dialysis patients

AU - Chang, Tae Ik

AU - Kang, Ea Wha

AU - Kim, Hyung Woo

AU - Ryu, Geun Woo

AU - Park, Cheol Ho

AU - Park, Jung Tak

AU - Yoo, Tae Hyun

AU - Shin, Sug Kyun

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Han, Dae Suk

AU - Han, Seung Hyeok

AU - Yang, Jingyun

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Low residual renal function (RRF) and serum bicarbonate are associated with adverse outcomes in peritoneal dialysis (PD) patients. However, a relationship between the 2 has not yet been determined in these patients. Therefore, this study aimed to investigate whether low serum bicarbonate has a deteriorating effect on RRF in PD patients. This prospective observational study included a total of 405 incident patients who started PD between January 2000 and December 2005. We determined risk factors for complete loss of RRF using competing risk methods and evaluated the effects of time-averaged serum bicarbonate (TA-Bic) on the decline of RRF over the first 3 years of dialysis treatment using generalized linear mixed models. During the first 3 years of dialysis, 95 (23.5%) patients became anuric. The mean time until patients became anuric was 20.8±9.0 months. After adjusting for multiple potentially confounding covariates, an increase in TA-Bic level was associated with a significantly decreased risk of loss of RRF (hazard ratio per 1 mEq/L increase, 0.84; 0.75-0.93; P = 0.002), and in comparison to TA-Bic ≥ 24 mEq/L, TA-Bic < 24 mEq/L conferred a 2.62-fold higher risk of becoming anuric. Furthermore, the rate of RRF decline estimated by generalized linear mixed models was significantly greater in patients with TA-Bic < 24 mEq/L compared with those with TA-Bic ≥ 24 mEq/L (-0.16 vs-0.11mL/min/mo/1.73m2, P< 0.001). In this study, a clear association was found between low serum bicarbonate and loss of RRF in PD patients. Nevertheless, whether correction of metabolic acidosis for this indication provides additional protection for preserving RRF in these patients is unknown. Future interventional studies should more appropriately address this question.

AB - Low residual renal function (RRF) and serum bicarbonate are associated with adverse outcomes in peritoneal dialysis (PD) patients. However, a relationship between the 2 has not yet been determined in these patients. Therefore, this study aimed to investigate whether low serum bicarbonate has a deteriorating effect on RRF in PD patients. This prospective observational study included a total of 405 incident patients who started PD between January 2000 and December 2005. We determined risk factors for complete loss of RRF using competing risk methods and evaluated the effects of time-averaged serum bicarbonate (TA-Bic) on the decline of RRF over the first 3 years of dialysis treatment using generalized linear mixed models. During the first 3 years of dialysis, 95 (23.5%) patients became anuric. The mean time until patients became anuric was 20.8±9.0 months. After adjusting for multiple potentially confounding covariates, an increase in TA-Bic level was associated with a significantly decreased risk of loss of RRF (hazard ratio per 1 mEq/L increase, 0.84; 0.75-0.93; P = 0.002), and in comparison to TA-Bic ≥ 24 mEq/L, TA-Bic < 24 mEq/L conferred a 2.62-fold higher risk of becoming anuric. Furthermore, the rate of RRF decline estimated by generalized linear mixed models was significantly greater in patients with TA-Bic < 24 mEq/L compared with those with TA-Bic ≥ 24 mEq/L (-0.16 vs-0.11mL/min/mo/1.73m2, P< 0.001). In this study, a clear association was found between low serum bicarbonate and loss of RRF in PD patients. Nevertheless, whether correction of metabolic acidosis for this indication provides additional protection for preserving RRF in these patients is unknown. Future interventional studies should more appropriately address this question.

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