Korean J Intern Med.
2017 Jan;32(1):109-116. 10.3904/kjim.2015.168.
The impact of high serum bicarbonate levels on mortality in hemodialysis patients
- Affiliations
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- 1Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
- 2Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea.
- 3Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
- 4Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea. dr52916@catholic.ac.kr
- 5Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
- 6Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
- 7Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
- 8Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- KMID: 2365985
- DOI: http://doi.org/10.3904/kjim.2015.168
Abstract
- 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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