Abstract | BACKGROUND: STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 5,810 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with a baseline estimated glomerular filtration rate (eGFR) > 60mL/min/1.73 m(2) using the CKD-EPI (CKD Epidemiology Collaboration) creatinine- cystatin C equation. PREDICTORS: OUTCOMES: Rapid kidney function decline (eGFR decline > 5% per year) and incident reduced eGFR (eGFR < 60mL/min/1.73 m(2) with minimum rate of eGFR loss of 1 mL/min/1.73 m(2) per year). RESULTS: Average bicarbonate concentration was 23.2 ± 1.8mEq/L. 1,730 (33%) participants had rapid kidney function decline, and 487 had incident reduced eGFR during follow-up. Each 1-SD lower baseline bicarbonate concentration was associated with 12% higher adjusted odds of rapid kidney function decline (95% CI, 6%-20%) and higher risk of incident reduced eGFR (adjusted incidence rate ratio, 1.11; 95% CI, 1.03-1.20) in models adjusting for demographics, baseline eGFR, albuminuria, and CKD risk factors. The OR for the associations of bicarbonate level < 21 mEq/L relative to 23-24 mEq/L was 1.35 (95% CI, 1.05-1.73) for rapid kidney function decline, and the incidence rate ratio was 1.16 (95% CI, 0.83-1.62) for incident reduced eGFR. LIMITATIONS: CONCLUSIONS: Lower serum bicarbonate concentrations are associated independently with rapid kidney function decline independent of eGFR or albuminuria in community-living persons with baseline eGFR > 60 mL/min/1.73 m(2). If confirmed, our findings suggest that metabolic acidosis may indicate either early kidney disease that is not captured by eGFR or albuminuria or may have a causal role in the development of eGFR < 60 mL/min/1.73 m(2).
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Authors | Todd H Driver, Michael G Shlipak, Ronit Katz, Leonard Goldenstein, Mark J Sarnak, Andrew N Hoofnagle, David S Siscovick, Bryan Kestenbaum, Ian H de Boer, Joachim H Ix |
Journal | American journal of kidney diseases : the official journal of the National Kidney Foundation
(Am J Kidney Dis)
Vol. 64
Issue 4
Pg. 534-41
(Oct 2014)
ISSN: 1523-6838 [Electronic] United States |
PMID | 24953891
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Bicarbonates
- Cystatin C
- Creatinine
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Topics |
- Acidosis
(blood)
- Aged
- Albuminuria
(epidemiology, metabolism)
- Atherosclerosis
(metabolism)
- Bicarbonates
(blood)
- Cohort Studies
- Creatinine
(analysis)
- Cystatin C
(analysis)
- Disease Progression
- Ethnicity
- Female
- Glomerular Filtration Rate
- Humans
- Kidney Function Tests
(methods)
- Male
- Middle Aged
- Outcome Assessment, Health Care
- Renal Insufficiency, Chronic
(diagnosis, ethnology, metabolism, physiopathology)
- Risk Factors
- Statistics as Topic
- United States
(epidemiology)
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