The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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The impact of high serum bicarbonate levels on mortality in hemodialysis patients

  • Chang, Kyung Yoon (Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Hyung Wook (Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Woo Jeong (Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Yong Kyun (Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Su-Hyun (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Song, Ho Chul (Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Young Ok (Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea) ;
  • Jin, Dong Chan (Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Choi, Euy Jin (Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Yang, Chul Woo (Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Yong-Lim (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Nam-Ho (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kang, Shin-Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Yon-Su (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Young Soo (Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2015.06.11
  • Accepted : 2015.08.04
  • Published : 2017.01.01
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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 ($tCO_2$) levels: quartile 1, a $tCO_2$ of < 19.4 mEq/L; quartile 2, a $tCO_2$ of 19.4 to 21.5 mEq/L; quartile 3, a $tCO_2$ of 21.6 to 23.9 mEq/L; and quartile 4, a $tCO_2$ of ${\geq}24mEq/L$. 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 $tCO_2$ of ${\geq}24mEq/L$) 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.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

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