Abstract
Background
Lower serum bicarbonate levels are associated with an increased risk of kidney disease progression. Whether lower serum bicarbonate levels are associated with an increased risk of developing acute kidney injury (AKI) is unclear.
Methods
We included 8393 patients from the Systolic Blood Pressure Intervention Trial (SPRINT) that had baseline serum bicarbonate levels and complete data available. AKI was a predetermined adjudicated adverse event that was determined by hospital admission and discharge records with AKI as a recorded diagnosis. Serum bicarbonate was examined in clinically significant cutoffs ≤ 24, 25–28 and > 28 mEq/L, with 25–28 mEq/L as the reference group. Cox proportional hazard models were used to examine the association between serum bicarbonate and development of AKI.
Results
The mean (SD) age, estimated glomerular filtration rate (eGFR), and serum bicarbonate level at baseline were 68 (9) years, 77 (23) ml/min/1.73m2 and 26.3 (2.6) mEq/L, respectively. Participants with serum bicarbonate levels ≤ 24 mEq/L were more likely to be male and to have lower baseline eGFR. After a median follow-up time of 3.3 years, 293 participants developed AKI. More patients in the lower bicarbonate group developed AKI (6.1% vs 2.8% in the 25–28 mEq/L and 2.1% in the > 28 mEq/L). A bicarbonate level ≤ 24 mEq/L was associated with a significantly increased risk of AKI compared to those with a bicarbonate level of 25–28 mEq/L after full adjustment (HR 1.42, 95% CI 1.1–1.8).
Conclusion
Lower serum bicarbonate levels are an independent risk factor for the development of AKI.
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Funding
This work was supported by the National Heart Blood and Lung Institute (NHBLI) R01 HL132868 (JK), VA CDA2 CX001030 (AJ), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01 DK121516-01 (MC).
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All authors contributed to the study conception and design. All authors contributed to data acquisition and interpretation. Dr. ZY was responsible for the statistical analysis. The first draft of the manuscript was written by Dr. JK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The authors of this manuscript have no conflicts of interest to declare.
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Institutional review boards reviewed and approved the SPRINT protocol at all clinical sites. De-identified data from the SPRINT trial were obtained from the National Heart, Lung and Blood Institute (NHLBI) Data Repository for this analysis.
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Kendrick, J., Chonchol, M., You, Z. et al. Lower serum bicarbonate is associated with an increased risk of acute kidney injury. J Nephrol 34, 433–439 (2021). https://doi.org/10.1007/s40620-020-00747-8
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DOI: https://doi.org/10.1007/s40620-020-00747-8