Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary
Rationale & Objective: Metabolic acidosis related to chronic kidney disease (CKD) is associated with an accelerated decline in glomerular filtration rate (GFR) and the development of end-stage kidney disease. Whether metabolic acidosis is associated with cardiovascular (CV) events in patient...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-09-01
|
| Series: | Kidney Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059521001151 |
| _version_ | 1818391084086067200 |
|---|---|
| author | David Collister Thomas W. Ferguson Susan E. Funk Nancy L. Reaven Vandana Mathur Navdeep Tangri |
| author_facet | David Collister Thomas W. Ferguson Susan E. Funk Nancy L. Reaven Vandana Mathur Navdeep Tangri |
| author_sort | David Collister |
| collection | DOAJ |
| description | Rationale & Objective: Metabolic acidosis related to chronic kidney disease (CKD) is associated with an accelerated decline in glomerular filtration rate (GFR) and the development of end-stage kidney disease. Whether metabolic acidosis is associated with cardiovascular (CV) events in patients with CKD is unclear. Study Design: Retrospective cohort study. Setting & Participants: The Optum De-identified Electronic Health Records Dataset, 2007–2017, was used to generate a cohort of patients with non-dialysis-dependent CKD who had at least 3 estimated GFR < 60 mL/min/1.73 m2. Patients with metabolic acidosis (serum bicarbonate 12 to <22 mEq/L) or normal serum bicarbonate (22‒29 mEq/L) at baseline were identified by 2 consecutive measurements 28‒365 days apart. Predictor: Serum bicarbonate as a continuous variable. Outcome: Primary outcome was a composite of major adverse cardiovascular events (MACE+). Secondary outcomes included individual components of the composite outcome. Analytical Approach: Cox proportional hazards models to evaluate the association between 1-mEq/L increments in serum bicarbonate and MACE+. Results: A total of 51,558 patients were evaluated, 34% had metabolic acidosis. The median follow-up period was 3.9–4.5 years, depending on the outcome assessed. The adjusted hazard ratio (HR) for MACE+ was 0.964 (95% CI, 0.961–0.968). For the individual components of incident heart failure (HF), stroke, myocardial infarction (MI), and CV death, HRs were 0.98 (95% CI, 0.97–0.98), 0.98 (95% CI, 0.97–0.99), 0.96 (95% CI, 0.96–0.97), and 0.94 (95% CI, 0.93–0.94), respectively, for every 1-mEq/L increase in serum bicarbonate. Limitations: Possible residual confounding. Conclusions: Metabolic acidosis in CKD is associated with an increased risk of MACE+ as well as the individual components of incident HF, stroke, MI, and CV death. Randomized controlled trials evaluating treatments for the correction of metabolic acidosis in CKD to prevent CV events are needed. |
| first_indexed | 2024-12-14T05:07:54Z |
| format | Article |
| id | doaj.art-e08cffb18e9d4f4fb3dcf0fd67c103f0 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-12-14T05:07:54Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-e08cffb18e9d4f4fb3dcf0fd67c103f02022-12-21T23:16:04ZengElsevierKidney Medicine2590-05952021-09-0135753761.e1Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language SummaryDavid Collister0Thomas W. Ferguson1Susan E. Funk2Nancy L. Reaven3Vandana Mathur4Navdeep Tangri5Department of Medicine, McMaster University, Hamilton, ON, CanadaDepartment of Internal Medicine, Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, CanadaStrategic Health Resources, La Cañada, CAStrategic Health Resources, La Cañada, CAMathur Consulting, Woodside, CADepartment of Internal Medicine, Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Address for Correspondence: Navdeep Tangri, MD, PhD, Seven Oaks General Hospital, 2LB19-2300 McPhillips St, Winnipeg, MB, Canada R2V 3M3.Rationale & Objective: Metabolic acidosis related to chronic kidney disease (CKD) is associated with an accelerated decline in glomerular filtration rate (GFR) and the development of end-stage kidney disease. Whether metabolic acidosis is associated with cardiovascular (CV) events in patients with CKD is unclear. Study Design: Retrospective cohort study. Setting & Participants: The Optum De-identified Electronic Health Records Dataset, 2007–2017, was used to generate a cohort of patients with non-dialysis-dependent CKD who had at least 3 estimated GFR < 60 mL/min/1.73 m2. Patients with metabolic acidosis (serum bicarbonate 12 to <22 mEq/L) or normal serum bicarbonate (22‒29 mEq/L) at baseline were identified by 2 consecutive measurements 28‒365 days apart. Predictor: Serum bicarbonate as a continuous variable. Outcome: Primary outcome was a composite of major adverse cardiovascular events (MACE+). Secondary outcomes included individual components of the composite outcome. Analytical Approach: Cox proportional hazards models to evaluate the association between 1-mEq/L increments in serum bicarbonate and MACE+. Results: A total of 51,558 patients were evaluated, 34% had metabolic acidosis. The median follow-up period was 3.9–4.5 years, depending on the outcome assessed. The adjusted hazard ratio (HR) for MACE+ was 0.964 (95% CI, 0.961–0.968). For the individual components of incident heart failure (HF), stroke, myocardial infarction (MI), and CV death, HRs were 0.98 (95% CI, 0.97–0.98), 0.98 (95% CI, 0.97–0.99), 0.96 (95% CI, 0.96–0.97), and 0.94 (95% CI, 0.93–0.94), respectively, for every 1-mEq/L increase in serum bicarbonate. Limitations: Possible residual confounding. Conclusions: Metabolic acidosis in CKD is associated with an increased risk of MACE+ as well as the individual components of incident HF, stroke, MI, and CV death. Randomized controlled trials evaluating treatments for the correction of metabolic acidosis in CKD to prevent CV events are needed.http://www.sciencedirect.com/science/article/pii/S2590059521001151Cardiovascularchronic kidney diseaseCKDheart failuremajor adverse cardiovascular eventsmetabolic acidosis |
| spellingShingle | David Collister Thomas W. Ferguson Susan E. Funk Nancy L. Reaven Vandana Mathur Navdeep Tangri Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary Kidney Medicine Cardiovascular chronic kidney disease CKD heart failure major adverse cardiovascular events metabolic acidosis |
| title | Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary |
| title_full | Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary |
| title_fullStr | Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary |
| title_full_unstemmed | Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary |
| title_short | Metabolic Acidosis and Cardiovascular Disease in CKDPlain-Language Summary |
| title_sort | metabolic acidosis and cardiovascular disease in ckdplain language summary |
| topic | Cardiovascular chronic kidney disease CKD heart failure major adverse cardiovascular events metabolic acidosis |
| url | http://www.sciencedirect.com/science/article/pii/S2590059521001151 |
| work_keys_str_mv | AT davidcollister metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary AT thomaswferguson metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary AT susanefunk metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary AT nancylreaven metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary AT vandanamathur metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary AT navdeeptangri metabolicacidosisandcardiovasculardiseaseinckdplainlanguagesummary |