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KMID : 0338420170320010109
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The Korean Journal of Internal Medicine
2017 Volume.32 No. 1 p.109 ~ p.116
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The impact of high serum bicarbonate levels on mortality in hemodialysis patients
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Chang Kyung-Yoon
Kim Hyung-Wook
Kim Woo-Jeong
Kim Yong-Kyun
Kim Su-Hyun
Song Ho-Chul
Kim Young-Ok
Jin Dong-Chan
Choi Euy-Jin
Yang Chul-Woo
Kim Yong-Lim
Kim Nam-Ho
Kang Shin-Wook
Kim Yon-Su
Kim Young-Soo
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Abstract
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Background/Aims: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients.
Methods: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality.
Results: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04).
Conclusions: Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.
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KEYWORD
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Renal dialysis, Bicarbonates, Alkalosis, Mortality
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