The Korean journal of internal medicine

  • 제32권1호
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  • Pages.109-116
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  • 2017
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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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)
  • 투고 : 2015.06.11
  • 심사 : 2015.08.04
  • 발행 : 2017.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

과제정보

연구 과제 주관 기관 : Ministry of Health and Welfare

참고문헌

  1. Levin A, Stevens PE. Summary of KDIGO 2012 CKD guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int 2014;85:49-61. https://doi.org/10.1038/ki.2013.444
  2. Tentori F, Karaboyas A, Robinson BM, et al. Association of dialysate bicarbonate concentration with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2013;62:738-746. https://doi.org/10.1053/j.ajkd.2013.03.035
  3. Chen W, Abramowitz MK. Treatment of metabolic acidosis in patients with CKD. Am J Kidney Dis 2014;63:311-317. https://doi.org/10.1053/j.ajkd.2013.06.017
  4. Uribarri J, Levin NW, Delmez J, et al. Association of acidosis and nutritional parameters in hemodialysis patients. Am J Kidney Dis 1999;34:493-499. https://doi.org/10.1016/S0272-6386(99)70077-6
  5. Heguilen RM, Sciurano C, Bellusci AD, et al. The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients. Nephrol Dial Transplant 2005;20:591-597. https://doi.org/10.1093/ndt/gfh661
  6. Di Iorio B, Torraca S, Piscopo C, et al. Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: pilot study of single dialysis effects. J Nephrol 2012;25:653-667. https://doi.org/10.5301/jn.5000036
  7. Sethi D, Curtis JR, Topham DL, Gower PE. Acute metabolic alkalosis during haemodialysis. Nephron 1989;51:119-120. https://doi.org/10.1159/000185265
  8. Kaye M, Somerville PJ, Lowe G, Ketis M, Schneider W. Hypocalcemic tetany and metabolic alkalosis in a dialysis patient: an unusual event. Am J Kidney Dis 1997;30:440-444. https://doi.org/10.1016/S0272-6386(97)90292-4
  9. Bommer J, Locatelli F, Satayathum S, et al. Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:661-671. https://doi.org/10.1016/S0272-6386(04)00936-9
  10. Wu DY, Shinaberger CS, Regidor DL, McAllister CJ, Kopple JD, Kalantar-Zadeh K. Association between serum bicarbonate and death in hemodialysis patients: is it better to be acidotic or alkalotic? Clin J Am Soc Nephrol 2006;1:70-78.
  11. Vashistha T, Kalantar-Zadeh K, Molnar MZ, Torlen K, Mehrotra R. Dialysis modality and correction of uremic metabolic acidosis: relationship with all-cause and cause-specific mortality. Clin J Am Soc Nephrol 2013;8:254-264. https://doi.org/10.2215/CJN.05780612
  12. Depner TA, Daugirdas JT. Equations for normalized protein catabolic rate based on two-point modeling of hemodialysis urea kinetics. J Am Soc Nephrol 1996;7:780-785.
  13. Gabutti L, Ferrari N, Giudici G, Mombelli G, Marone C. Unexpected haemodynamic instability associated with standard bicarbonate haemodialysis. Nephrol Dial Transplant 2003;18:2369-2376. https://doi.org/10.1093/ndt/gfg383
  14. Graham KA, Hoenich NA, Goodship TH. Pre and interdialytic acid-base balance in hemodialysis patients. Int J Artif Organs 2001;24:192-196. https://doi.org/10.1177/039139880102400404
  15. Pifer TB, McCullough KP, Port FK, et al. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 2002;62:2238-2245. https://doi.org/10.1046/j.1523-1755.2002.00658.x
  16. Mapes DL, Lopes AA, Satayathum S, et al. Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 2003;64:339-349. https://doi.org/10.1046/j.1523-1755.2003.00072.x
  17. Leavey SF, Strawderman RL, Young EW, et al. Cross-sectional and longitudinal predictors of serum albumin in hemodialysis patients. Kidney Int 2000;58:2119-2128. https://doi.org/10.1111/j.1523-1755.2000.00385.x
  18. Thet Z, Win AK, Pedagogos E, Beavis J, Crikis S, Nelson C. Differential effects of phosphate binders on pre-dialysis serum bicarbonate in end-stage kidney disease patients on maintenance haemodialysis. BMC Nephrol 2013;14:205. https://doi.org/10.1186/1471-2369-14-205

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