The impact of high serum bicarbonate levels on mortality in hemodialysis patients

Kyung Yoon Chang, Hyung Wook Kim, Woo Jeong Kim, Yong Kyun Kim, Su Hyun Kim, Ho Chul Song, Young Ok Kim, Dong Chan Jin, Euy Jin Choi, Chul Woo Yang, Yong Lim Kim, Nam Ho Kim, Shin Wook Kang, Yon Su Kim, Young Soo Kim

Research output: Contribution to journalArticle

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Abstract

Background/Aims: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Methods: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. Results: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Conclusions: Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

Original languageEnglish
Article numberPMC5214722
Pages (from-to)109-116
Number of pages8
JournalKorean Journal of Internal Medicine
Volume32
Issue number1
DOIs
Publication statusPublished - 2017 Jan

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Bicarbonates
Renal Dialysis
Mortality
Serum
Proportional Hazards Models
Confidence Intervals
Alkalosis
Kaplan-Meier Estimate
Korea
Carbon Dioxide
Chronic Kidney Failure
Registries
dioxotechnetium
Regression Analysis
Research

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Chang, K. Y., Kim, H. W., Kim, W. J., Kim, Y. K., Kim, S. H., Song, H. C., ... Kim, Y. S. (2017). The impact of high serum bicarbonate levels on mortality in hemodialysis patients. Korean Journal of Internal Medicine, 32(1), 109-116. [PMC5214722]. https://doi.org/10.3904/kjim.2015.168
Chang, Kyung Yoon ; Kim, Hyung Wook ; Kim, Woo Jeong ; Kim, Yong Kyun ; Kim, Su Hyun ; Song, Ho Chul ; Kim, Young Ok ; Jin, Dong Chan ; Choi, Euy Jin ; Yang, Chul Woo ; Kim, Yong Lim ; Kim, Nam Ho ; Kang, Shin Wook ; Kim, Yon Su ; Kim, Young Soo. / The impact of high serum bicarbonate levels on mortality in hemodialysis patients. In: Korean Journal of Internal Medicine. 2017 ; Vol. 32, No. 1. pp. 109-116.
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abstract = "Background/Aims: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Methods: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. Results: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95{\%} CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95{\%} CI, 1.03 to 3.22; p = 0.04). Conclusions: Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.",
author = "Chang, {Kyung Yoon} and Kim, {Hyung Wook} and Kim, {Woo Jeong} and Kim, {Yong Kyun} and Kim, {Su Hyun} and Song, {Ho Chul} and Kim, {Young Ok} and Jin, {Dong Chan} and Choi, {Euy Jin} and Yang, {Chul Woo} and Kim, {Yong Lim} and Kim, {Nam Ho} and Kang, {Shin Wook} and Kim, {Yon Su} and Kim, {Young Soo}",
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Chang, KY, Kim, HW, Kim, WJ, Kim, YK, Kim, SH, Song, HC, Kim, YO, Jin, DC, Choi, EJ, Yang, CW, Kim, YL, Kim, NH, Kang, SW, Kim, YS & Kim, YS 2017, 'The impact of high serum bicarbonate levels on mortality in hemodialysis patients', Korean Journal of Internal Medicine, vol. 32, no. 1, PMC5214722, pp. 109-116. https://doi.org/10.3904/kjim.2015.168

The impact of high serum bicarbonate levels on mortality in hemodialysis patients. / Chang, Kyung Yoon; Kim, Hyung Wook; Kim, Woo Jeong; Kim, Yong Kyun; Kim, Su Hyun; Song, Ho Chul; Kim, Young Ok; Jin, Dong Chan; Choi, Euy Jin; Yang, Chul Woo; Kim, Yong Lim; Kim, Nam Ho; Kang, Shin Wook; Kim, Yon Su; Kim, Young Soo.

In: Korean Journal of Internal Medicine, Vol. 32, No. 1, PMC5214722, 01.2017, p. 109-116.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of high serum bicarbonate levels on mortality in hemodialysis patients

AU - Chang, Kyung Yoon

AU - Kim, Hyung Wook

AU - Kim, Woo Jeong

AU - Kim, Yong Kyun

AU - Kim, Su Hyun

AU - Song, Ho Chul

AU - Kim, Young Ok

AU - Jin, Dong Chan

AU - Choi, Euy Jin

AU - Yang, Chul Woo

AU - Kim, Yong Lim

AU - Kim, Nam Ho

AU - Kang, Shin Wook

AU - Kim, Yon Su

AU - Kim, Young Soo

PY - 2017/1

Y1 - 2017/1

N2 - Background/Aims: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Methods: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. Results: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Conclusions: Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

AB - Background/Aims: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Methods: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. Results: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Conclusions: Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

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