Abstract: TH-PO693
Association of Metabolic Acidosis with Adverse Cardiovascular Outcomes in Patients with CKD
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Reaven, Nancy L., Strategic Health Resources, La Canada, California, United States
- Funk, Susan E., Strategic Health Resources, La Canada, California, United States
- Mathur, Vandana S., Mathur Consulting, Woodside, California, United States
- Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
Background
Metabolic acidosis is a known risk factor for chronic kidney disease (CKD) progression. Less is known about its association with cardiovascular disease in patients with advanced CKD. Here we assess the association of metabolic acidosis with adverse cardiovascular outcomes and its role as an independent predictor of cardiovascular outcomes in patients with pre-dialysis CKD.
Methods
De-identified electronic medical records (Optum® EMR), 2007–2017 were queried to identify patients with CKD Stages 3-5 with ≥2 consistent serum bicarbonate values 28–365 days apart, ≥3 eGFR values >10 and <60 mL/min/1.73m2 and ≥2 years of post-index data or until death. Patients were followed for up to 10 years for evidence of new onset heart failure, stroke or acute myocardial infarction (MI), defined using ICD-9 and ICD-10 diagnosis codes. Metabolic acidosis and normal serum bicarbonate groups were defined by two serum bicarbonate values between 12 and <22 mEq/L and 22-29 mEq/L, respectively. Cox proportional hazards models were used to examine potential confounders: age, sex, race, eGFR, diabetes, hypertension, heart failure, coronary artery disease, peripheral vascular disease, and hemoglobin and serum albumin.
Results
51,558 patients qualified for this longitudinal observational study. The incidence of adverse cardiovascular events at 2 years was significantly higher in patients with metabolic acidosis compared to patients with normal serum bicarbonate, [heart failure: 29.8 % vs. 22.8%, p<0.0001; stroke: 19.5% vs. 17.2%, p<0.0001; MI: 17.2% vs. 12.3%, p<0.0001, respectively]. During the up to 10-years of follow-up, serum bicarbonate was independently associated with adverse cardiovascular outcomes; hazard ratios per 1 mEq/L change: new onset heart failure, 0.976, CI: 0.971-0.981, stroke, 0.979, CI: 0.973-0.985; and MI, 0.964, CI: 0.958-0.970, respectively.
Conclusion
In this longitudinal analysis of > 51,000 non-dialysis CKD patients followed for up to ten years, serum bicarbonate levels below 22 mEq/L were associated with increased incidence of major adverse cardiovascular events independent of age, comorbid conditions and kidney function. Studies evaluating the mechanisms of these associations are needed.
Funding
- Commercial Support –