title: Low Serum Bicarbonate Predicts Residual Renal Function Loss in Peritoneal Dialysis Patients.
abstract: Low residual renal function (RRF) and serum bicarbonate are associated with adverse outcomes in peritoneal dialysis (PD) patients. However, a relationship between the 2 has not yet been determined in these patients. Therefore, this study aimed to investigate whether low serum bicarbonate has a deteriorating effect on RRF in PD patients.This prospective observational study included a total of 405 incident patients who started PD between January 2000 and December 2005. We determined risk factors for complete loss of RRF using competing risk methods and evaluated the effects of time-averaged serum bicarbonate (TA-Bic) on the decline of RRF over the first 3 years of dialysis treatment using generalized linear mixed models.During the first 3 years of dialysis, 95 (23.5%) patients became anuric. The mean time until patients became anuric was 20.8 ± 9.0 months. After adjusting for multiple potentially confounding covariates, an increase in TA-Bic level was associated with a significantly decreased risk of loss of RRF (hazard ratio per 1 mEq/L increase, 0.84; 0.75-0.93; P = 0.002), and in comparison to TA-Bic ≥ 24 mEq/L, TA-Bic < 24 mEq/L conferred a 2.62-fold higher risk of becoming anuric. Furthermore, the rate of RRF decline estimated by generalized linear mixed models was significantly greater in patients with TA-Bic < 24 mEq/L compared with those with TA-Bic ≥ 24 mEq/L (-0.16 vs -0.11 mL/min/mo/1.73 m, P < 0.001).In this study, a clear association was found between low serum bicarbonate and loss of RRF in PD patients. Nevertheless, whether correction of metabolic acidosis for this indication provides additional protection for preserving RRF in these patients is unknown. Future interventional studies should more appropriately address this question.
authors.affiliation: From the Department of Internal Medicine (TIC, EWK, SKS), NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do; Department of Internal Medicine (HWK, GWR, CHP, JTP, T-HY, S-WK, KHC, DSH, SHH), College of Medicine, Yonsei University, Seoul; and Brain Korea 21 for Medical Science (S-WK), Severance Biomedical Science Institute, Yonsei University, Seoul, Republic of Korea.
authors.forename: Tae Ik
authors.initials: TI
authors.lastname: Chang
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.forename: Hyung Woo
authors.initials: HW
authors.lastname: Kim
authors.forename: Geun Woo
authors.initials: GW
authors.lastname: Ryu
authors.forename: Cheol Ho
authors.initials: CH
authors.lastname: Park
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Sug Kyun
authors.initials: SK
authors.lastname: Shin
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.forename: Dae Suk
authors.initials: DS
authors.lastname: Han
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001002:Anuria / Q000097:blood* / Q000453:epidemiology; D001639:Bicarbonates / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D001639:Bicarbonates