Kidney Week

Abstract: TH-PO452

Serum Bicarbonate and Pulse Wave Velocity in CKD – A Report from the CRIC Study

Session Information

• CKD: Epidemiology, Outcomes - Cardiovascular - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Dobre, Mirela A., Case Western Reserve University, Cleveland, Ohio, United States

Mirela A. Dobre,

• Townsend, Raymond R., University of Pennsylvania School of Medicine , Villanova, Pennsylvania, United States

Raymond R. Townsend,

• Yang, Wei, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Wei Yang,

• Anderson, Amanda Hyre, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Amanda Hyre Anderson,

• Batuman, Vecihi, Tulane University, New Orleans, Louisiana, United States

Vecihi Batuman,

• Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States

Jing Chen,

• Jaar, Bernard G., Johns Hopkins University and Nephrology Center of Maryland, Baltimore, Maryland, United States

Bernard G. Jaar,

• Kallem, Radhakrishna Reddy, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Radhakrishna Reddy Kallem,

• Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States

Hernan Rincon-Choles,

• Sozio, Stephen M., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Stephen M. Sozio,

• Steigerwalt, Susan P., University of Michigan, Ann Arbor, Michigan, United States

Susan P. Steigerwalt,

• Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Harold I. Feldman,

• Hostetter, Thomas H., Case Western Reserve University, Cleveland, Ohio, United States

Thomas H. Hostetter,

• Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States

Mahboob Rahman,

Background

Vascular stiffness is an important phenotype of cardiovascular disease (CVD) in patients with CKD. Though common in CKD, acid base disturbances as risk factors for CVD are not well studied. We aimed to test the association between serum bicarbonate and vascular stiffness as expressed by carotid femoral pulse wave velocity (cfPWV).

Methods

Serum bicarbonate and cfPWV were simultaneously measured in 3206 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) at study year 2. Serum bicarbonate was analyzed as a categorical variable using the following groups: <22 mEql/L, 22-26 mEq/L (reference group) and >26 mEq/L, and as a continuous variable using restricted cubic splines to accommodate potential nonlinear associations. The models were adjusted for age, sex, race, diabetes, smoking, CVD, hypertension, FGF 23, Calcium, eGFR and proteinuria.

Results

The mean eGFR was 43.3±17ml/min per 1.73m2 and mean serum bicarbonate was 23.9 mEq/L. Participants with serum bicarbonate < 22 and > 26 mEq/L had significantly higher cfPWV (10.04 and 9.84 m/s respectively) compared to reference group (9.47 m/s, p=0.004) ((Figure- Panel A). In non-linear models, we found a U-shaped association between serum bicarbonate and cfPWV (p<0.05), (Figure- Panel B).

Conclusion

In a large cohort of patients with CKD, serum bicarbonate below 22 or above 26 mEq/L was associated with higher cfPWV. Further studies are needed to determine if there is a direct causal link between acid base abnormalities and vascular stiffness and to define the optimal range of serum bicarbonate in CKD to prevent adverse clinical outcomes.

Funding

• Private Foundation Support