title: Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study.
abstract: Heart failure (HF) is a frequent occurrence in chronic kidney disease (CKD) patients and predicts poor survival. Serum bicarbonate is associated with increased rates of HF in CKD; however, the mechanisms leading to this association are incompletely understood. This study aims to assess whether serum bicarbonate is independently associated with structural and functional cardiac abnormalities in CKD.
  
  
  
  The association between serum bicarbonate and left ventricular (LV) hypertrophy (LVH), LV mass indexed to height2.7, LV geometry, ejection fraction (EF) and diastolic dysfunction was assessed in 3,483 participants without NYHA class III/IV HF, enrolled in the Chronic Renal Insufficiency Cohort study.
  
  
  
  The mean estimated glomerular filtration rate was 42.5 ± 17 ml/min/1.73 m2. The overall prevalence of LVH was 51.2%, with 57.8, 50.9 and 47.7% for bicarbonate categories <22, 22-26 and >26 mmol/l, respectively. Participants with low bicarbonate were more likely to have LVH and abnormal LV geometry (OR 1.32; 95% CI 1.07-1.64, and OR 1.57; 95% CI 1.14-2.16, respectively). However, the association was not statistically significant after adjustment for demographics, traditional cardiovascular risk factors, medications and kidney function (OR 1.07; 95% CI 0.66-1.72, and OR 1.27; 95% CI 0.64-2.51, respectively). No association was found between bicarbonate and systolic or diastolic dysfunction. During follow-up, no significant changes in LV mass or EF were observed in any bicarbonate strata.
  
  
  
  In a large CKD study, serum bicarbonate was associated with LV mass and concentric LVH; however, this association was attenuated after adjustment for clinical factors suggesting that the observed cardiac effects are mediated through yet unknown mechanisms.
authors.affiliation: Division of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio., USA.
authors.forename: Mirela
authors.initials: M
authors.lastname: Dobre
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.forename: Kaixiang
authors.initials: K
authors.lastname: Tao
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.forename: Paul
authors.initials: P
authors.lastname: Drawz
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.forename: Thomas
authors.initials: T
authors.lastname: Hostetter
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Claudia
authors.initials: C
authors.lastname: Lora
authors.forename: Akinlolu O
authors.initials: AO
authors.lastname: Ojo
authors.forename: Kumar
authors.initials: K
authors.lastname: Shrama
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
mesh_terms: D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D016277:Ventricular Function, Left
chemical_list: D001639:Bicarbonates