Acute Kidney Injury Linked to Lower Bicarbonate Levels
Individuals with a serum bicarbonate level below 24 mEq/L have a 2-fold increased risk of AKI compared with those with a level of 25–28 mEq/L.
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SAN DIEGO—Lower serum bicarbonate levels are independently associated with an increased risk of acute kidney injury (AKI), according to study findings presented at the American Society of Nephrology's Kidney Week 2018 conference.
Compared with individuals who have a serum bicarbonate level (in mEq/L) of 25–28 (reference), those with a level of 24 or below had a significant 43% increased risk of AKI in a fully adjusted model, investigators led by Jessica B. Kendrick, MD, MPH, of the University of Colorado School of Medicine in Aurora, reported. Bicarbonate levels above 28 were not associated with AKI risk.
The study included 8393 patients who participated in the Systolic Blood Pressure Intervention Trial (SPRINT), a multicenter, randomized trial looking at the effect of targeting a lower blood pressure on cardiovascular and kidney disease and the brain. At baseline, patients had a mean age of 68 years and mean estimated glomerular filtration rate of 77 mL/min/1.73 m2. AKI developed in 293 individuals after a median follow-up time of 3.3 years. AKI developed in 6.1% of individuals with a bicarbonate level of 24 or below compared with 2.8% and 2.1% of those with bicarbonate levels of 25 to 28 and greater than 28, respectively.
“Our data add to the growing literature that acid retention has significant adverse impacts,” Dr Kendrick told Renal & Urology News. “In this study, we found that lower serum bicarbonate levels were a significant risk factor for the development of AKI. Further studies are needed to confirm our findings and to determine if correction of metabolic acidosis may have a protective role in preventing AKI.”
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Shah NR, You Z, Jovanovich AJ, et al. Lower serum bicarbonate is associated with an increased risk of AKI. Presented at the American Society of Nephrology's 2018 Kidney Week meeting in San Diego, Oct. 23-28. Abstract TH-PO018.