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Low Serum Bicarbonate Predicts Residual Renal Function Loss in Peritoneal Dialysis Patients

 Tae Ik Chang  ;  Ea Wha Kang  ;  Hyung Woo Kim  ;  Geun Woo Ryu  ;  Cheol Ho Park  ;  Jung Tak Park  ;  Tae-Hyun Yoo  ;  Sug Kyun Shin  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Dae Suk Han  ;  Seung Hyeok Han 
 MEDICINE, Vol.94(31) : 1276, 2015 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Anuria/blood* ; Anuria/epidemiology ; Bicarbonates/blood* ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney Failure, Chronic/blood* ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Peritoneal Dialysis* ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Time Factors ; Young Adult
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kang, Ea Wha(강이화)
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Ryu, Geun Woo(류근우)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Park, Cheol Ho(박철호) ORCID logo https://orcid.org/0000-0003-4636-5745
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Chang, Tae Ik(장태익)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Dae Suk(한대석)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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