title: High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients.
abstract: BACKGROUND
  Metabolic acidosis leads to chronic kidney disease (CKD) progression. The guidelines recommend a lower limit of serum bicarbonate level, but no upper limit. For serum bicarbonate level to be clinically useful as a therapeutic target marker, it is necessary to investigate the target serum bicarbonate level within the normal range to prevent CKD progression.
  
  
  METHODS
  One hundred and thirteen elderly CKD patients, whose serum bicarbonate level was controlled within the normal range, were enrolled in this retrospective cohort study in Ibaraki, Japan. Outcome was defined as a decrease of 25% or more in estimated glomerular filtration rate (eGFR) or starting dialysis. We used Cox proportional hazard models adjusted for patients' characteristics to examine the association between serum bicarbonate level and the outcome.
  
  
  RESULTS
  Female patients were 36.3%: average age (SD), 70.4 (6.6) years; eGFR, 25.7 (13.6) ml/min/1.73 m(2); serum bicarbonate level, 27.4 (3.2) mEq/l. Patients with the lowest quartile of serum bicarbonate levels [23.4 (1.8) mEq/l] showed a high risk of CKD progression compared with patients with high serum bicarbonate levels [28.8 (2.3) mEq/l]: adjusted hazard ratio (HR), 3.511 (95% CI, 1.342-9.186). A 1 mEq/l increase in serum bicarbonate level was associated with a low risk of CKD progression: adjusted HR, 0.791 [95% confidence interval (CI), 0.684-0.914].
  
  
  CONCLUSIONS
  In elderly CKD patients, our findings suggest that serum bicarbonate level is independently associated with CKD progression, and that a high serum bicarbonate level is associated with a low risk of CKD progression. A high target serum bicarbonate level within the normal range may be effective for preventing CKD progression.
authors.affiliation: Department of Nephrology, Tokyo Kyosai Hospital, Meguroku, Japan. tokyo.kyosai.kanda@gmail.com
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.forename: Masumi
authors.initials: M
authors.lastname: Ai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Renjiro
authors.initials: R
authors.lastname: Kuriyama
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shiigai
mesh_terms: D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001639:Bicarbonates; D015415:Biomarkers