Association of serum bicarbonate with incident functional limitation in older adults.
OBJECTIVE
Cross-sectional studies have found that low serum bicarbonate is associated with slower gait speed. Whether bicarbonate levels independently predict the development of functional limitation has not been previously studied. Whether bicarbonate was associated with incident persistent lower extremity functional limitation and whether the relationship differed in individuals with and without CKD were assessed in participants in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals


METHODS
Functional limitation was defined as difficulty in walking 0.25 miles or up 10 stairs on two consecutive reports 6 months apart in the same activity (stairs or walking). Kidney function was measured using eGFR by the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and CKD was defined as an eGFR<60 ml/min per 1.73 m(2). Serum bicarbonate was measured using arterialized venous blood gas. Cox proportional hazards analysis was used to assess the association of bicarbonate (<23, 23-25.9, and ≥26 mEq/L) with functional limitation. Mixed model linear regression was performed to assess the association of serum bicarbonate on change in gait speed over time.


RESULTS
Of 1544 participants, 412 participants developed incident persistent functional limitation events over a median 4.4 years (interquartile range, 3.1 to 4.5). Compared with ≥26 mEq/L, lower serum bicarbonate was associated with functional limitation. After adjustment for demographics, CKD, diabetes, body mass index, smoking, diuretic use, and gait speed, lower serum bicarbonate was significantly associated with functional limitation (hazard ratio, 1.35; 95% confidence interval, 1.08 to 1.68 and hazard ratio, 1.58; 95% confidence interval, 1.12 to 2.22 for bicarbonate levels from 23 to 25.9 and <23, respectively). There was not a significant interaction of bicarbonate with CKD. In addition, bicarbonate was not significantly associated with change in gait speed.


CONCLUSIONS
Lower serum bicarbonate was associated with greater risk of incident, persistent functional limitation. This association was present in individuals with and without CKD.
Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
Robert
R
Yenchek
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Joachim H
JH
Ix
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Dena E
DE
Rifkin
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Michael G
MG
Shlipak
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Mark J
MJ
Sarnak
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Melissa
M
Garcia
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Kushang V
KV
Patel
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Suzanne
S
Satterfield
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Tamara B
TB
Harris
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Anne B
AB
Newman
Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. Linda.Fried@va.gov.
Linda F
LF
Fried
D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D005260:Female; D005684:Gait / Q000502:physiology*; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000503:physiopathology*; D057566:Self Report; D016138:Walking / Q000502:physiology*
D001639:Bicarbonates
CKD; acidosis; clinical epidemiology; geriatric; nephrology