Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

Mirela Dobre, Jason Roy, Kaixiang Tao, Amanda H. Anderson, Nisha Bansal, Jing Chen, Rajat Deo, Paul Drawz, Harold I. Feldman, L. Lee Hamm, Thomas Hostetter, John W. Kusek, Claudia Lora, Akinlolu O. Ojo, Kumar Shrama, Mahboob Rahman

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4 Scopus citations

Abstract

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 height 2.7 , 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 m 2 . 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.

Original languageEnglish (US)
Pages (from-to)411-420
Number of pages10
JournalAmerican Journal of Nephrology
Volume43
Issue number6
DOIs
StatePublished - Jul 1 2016

Keywords

  • Chronic kidney disease
  • Left ventricular geometry
  • Left ventricular hypertrophy
  • Serum bicarbonate

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    Dobre, M., Roy, J., Tao, K., Anderson, A. H., Bansal, N., Chen, J., Deo, R., Drawz, P., Feldman, H. I., Hamm, L. L., Hostetter, T., Kusek, J. W., Lora, C., Ojo, A. O., Shrama, K., & Rahman, M. (2016). Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study. American Journal of Nephrology, 43(6), 411-420. https://doi.org/10.1159/000446860