Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort
ABSTRACT Background We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (t...
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| Veröffentlicht in: | Clinical kidney journal 2024-11, Vol.17 (11), p.sfae254 |
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| creator | Lombardi, Gianmarco Chesnaye, Nicholas C Caskey, Fergus J Dekker, Friedo W Evans, Marie Heimburger, Olof Pippias, Maria Torino, Claudia Szymczak, Maciej Drechsler, Christiane Wanner, Christoph Gambaro, Giovanni Stel, Vianda S Jager, Kitty J Ferraro, Pietro Manuel |
| description | ABSTRACT
Background
We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD) and during KRT.
Methods
Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality.
Results
We included 1485 patients with a median follow-up of 2.9 (interquartile range 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (P = .03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (P = .01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (P = .13). We observed effect modification by subjective global assessment category (P-value for interaction = .02) and KRT (P-value for interaction = .02).
Conclusions
A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.
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| fullrecord | <record><control><sourceid>gale_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_882806</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A820323330</galeid><oup_id>10.1093/ckj/sfae254</oup_id><sourcerecordid>A820323330</sourcerecordid><originalsourceid>FETCH-LOGICAL-c406t-f16ea6ade27143e0086d766d618ebbe4c6d11f93691681ab90f3031561f6f5b43</originalsourceid><addsrcrecordid>eNp9kl1rHCEUhqW0NGGbq94XoVAKZRIdZ9yZ3oQlpB-wUArNtTh63DE7o1t1EvYf9GfXMNulC6UKejjnOa--cBB6TcklJS27Utv7q2gklHX1DJ2XpGqKpqbs-TEm9Rm6iPGe5JUrpKpfojPWct7m4xz9Wnu3sWnS1skBRwjTiDurZOi8kwmwdBqPPiQ52LTHwcYttg77QUPAO5ksuBTxo009lvpBOgUaqz54ZxXeWu1gj7WNICN8zFJy2EeI2AQ_4tQDvv1-t1pj5fv8wCv0wsghwsXhXqC7T7c_br4U62-fv96s1oWqCE-FoRwklxrKJa0YZE9cLznXnDbQdVAprik1LeMt5Q2VXUsMI4zWnBpu6q5iC1TMuvERdlMndsGOMuyFl1YcUtscgWiasiE889cznysjaJUNBzmctJ1WnO3Fxj8ISjmr2ZJlhfcHheB_ThCTGG1UMAzSgZ-iYLTieZF2mdG3M7qRAwjrjM-S6gkXq6YkrGQsu1mgy39QeWsYrfIOjM35k4YPc4MKPsYA5vh9SsTTGIk8RuIwRpl-87fjI_tnaDLwbgb8tPuv0m9ja9M7</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3146666097</pqid></control><display><type>article</type><title>Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort</title><source>Oxford Journals Open Access Collection</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>SWEPUB Freely available online</source><creator>Lombardi, Gianmarco ; Chesnaye, Nicholas C ; Caskey, Fergus J ; Dekker, Friedo W ; Evans, Marie ; Heimburger, Olof ; Pippias, Maria ; Torino, Claudia ; Szymczak, Maciej ; Drechsler, Christiane ; Wanner, Christoph ; Gambaro, Giovanni ; Stel, Vianda S ; Jager, Kitty J ; Ferraro, Pietro Manuel</creator><creatorcontrib>Lombardi, Gianmarco ; Chesnaye, Nicholas C ; Caskey, Fergus J ; Dekker, Friedo W ; Evans, Marie ; Heimburger, Olof ; Pippias, Maria ; Torino, Claudia ; Szymczak, Maciej ; Drechsler, Christiane ; Wanner, Christoph ; Gambaro, Giovanni ; Stel, Vianda S ; Jager, Kitty J ; Ferraro, Pietro Manuel ; EQUAL study investigators ; the EQUAL study investigators</creatorcontrib><description>ABSTRACT
Background
We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD) and during KRT.
Methods
Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality.
Results
We included 1485 patients with a median follow-up of 2.9 (interquartile range 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (P = .03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (P = .01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (P = .13). We observed effect modification by subjective global assessment category (P-value for interaction = .02) and KRT (P-value for interaction = .02).
Conclusions
A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.
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10.1093/ckj/sfae254
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6363834913112</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfae254</identifier><identifier>PMID: 39669396</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged patients ; Bicarbonates ; Carbonates ; Chronic kidney failure ; Health aspects ; Measurement ; Mortality ; Netherlands ; Original ; Patient outcomes ; Physiological aspects ; Prognosis</subject><ispartof>Clinical kidney journal, 2024-11, Vol.17 (11), p.sfae254</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.</rights><rights>COPYRIGHT 2024 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c406t-f16ea6ade27143e0086d766d618ebbe4c6d11f93691681ab90f3031561f6f5b43</cites><orcidid>0000-0003-2298-1420 ; 0000-0001-9507-5301 ; 0000-0002-1379-022X ; 0000-0002-0007-1947 ; 0000-0001-5733-2370 ; 0000-0003-0444-8569 ; 0000-0001-8650-5795</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635373/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635373/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,723,776,780,860,881,1598,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39669396$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:160009168$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Lombardi, Gianmarco</creatorcontrib><creatorcontrib>Chesnaye, Nicholas C</creatorcontrib><creatorcontrib>Caskey, Fergus J</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Heimburger, Olof</creatorcontrib><creatorcontrib>Pippias, Maria</creatorcontrib><creatorcontrib>Torino, Claudia</creatorcontrib><creatorcontrib>Szymczak, Maciej</creatorcontrib><creatorcontrib>Drechsler, Christiane</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Gambaro, Giovanni</creatorcontrib><creatorcontrib>Stel, Vianda S</creatorcontrib><creatorcontrib>Jager, Kitty J</creatorcontrib><creatorcontrib>Ferraro, Pietro Manuel</creatorcontrib><creatorcontrib>EQUAL study investigators</creatorcontrib><creatorcontrib>the EQUAL study investigators</creatorcontrib><title>Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort</title><title>Clinical kidney journal</title><addtitle>Clin Kidney J</addtitle><description>ABSTRACT
Background
We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD) and during KRT.
Methods
Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality.
Results
We included 1485 patients with a median follow-up of 2.9 (interquartile range 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (P = .03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (P = .01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (P = .13). We observed effect modification by subjective global assessment category (P-value for interaction = .02) and KRT (P-value for interaction = .02).
Conclusions
A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.
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10.1093/ckj/sfae254
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6363834913112</description><subject>Aged patients</subject><subject>Bicarbonates</subject><subject>Carbonates</subject><subject>Chronic kidney failure</subject><subject>Health aspects</subject><subject>Measurement</subject><subject>Mortality</subject><subject>Netherlands</subject><subject>Original</subject><subject>Patient outcomes</subject><subject>Physiological aspects</subject><subject>Prognosis</subject><issn>2048-8505</issn><issn>2048-8513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>D8T</sourceid><recordid>eNp9kl1rHCEUhqW0NGGbq94XoVAKZRIdZ9yZ3oQlpB-wUArNtTh63DE7o1t1EvYf9GfXMNulC6UKejjnOa--cBB6TcklJS27Utv7q2gklHX1DJ2XpGqKpqbs-TEm9Rm6iPGe5JUrpKpfojPWct7m4xz9Wnu3sWnS1skBRwjTiDurZOi8kwmwdBqPPiQ52LTHwcYttg77QUPAO5ksuBTxo009lvpBOgUaqz54ZxXeWu1gj7WNICN8zFJy2EeI2AQ_4tQDvv1-t1pj5fv8wCv0wsghwsXhXqC7T7c_br4U62-fv96s1oWqCE-FoRwklxrKJa0YZE9cLznXnDbQdVAprik1LeMt5Q2VXUsMI4zWnBpu6q5iC1TMuvERdlMndsGOMuyFl1YcUtscgWiasiE889cznysjaJUNBzmctJ1WnO3Fxj8ISjmr2ZJlhfcHheB_ThCTGG1UMAzSgZ-iYLTieZF2mdG3M7qRAwjrjM-S6gkXq6YkrGQsu1mgy39QeWsYrfIOjM35k4YPc4MKPsYA5vh9SsTTGIk8RuIwRpl-87fjI_tnaDLwbgb8tPuv0m9ja9M7</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Lombardi, Gianmarco</creator><creator>Chesnaye, Nicholas C</creator><creator>Caskey, Fergus J</creator><creator>Dekker, Friedo W</creator><creator>Evans, Marie</creator><creator>Heimburger, Olof</creator><creator>Pippias, Maria</creator><creator>Torino, Claudia</creator><creator>Szymczak, Maciej</creator><creator>Drechsler, Christiane</creator><creator>Wanner, Christoph</creator><creator>Gambaro, Giovanni</creator><creator>Stel, Vianda S</creator><creator>Jager, Kitty J</creator><creator>Ferraro, Pietro Manuel</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-2298-1420</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid><orcidid>https://orcid.org/0000-0002-1379-022X</orcidid><orcidid>https://orcid.org/0000-0002-0007-1947</orcidid><orcidid>https://orcid.org/0000-0001-5733-2370</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0001-8650-5795</orcidid></search><sort><creationdate>20241101</creationdate><title>Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort</title><author>Lombardi, Gianmarco ; Chesnaye, Nicholas C ; Caskey, Fergus J ; Dekker, Friedo W ; Evans, Marie ; Heimburger, Olof ; Pippias, Maria ; Torino, Claudia ; Szymczak, Maciej ; Drechsler, Christiane ; Wanner, Christoph ; Gambaro, Giovanni ; Stel, Vianda S ; Jager, Kitty J ; Ferraro, Pietro Manuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-f16ea6ade27143e0086d766d618ebbe4c6d11f93691681ab90f3031561f6f5b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged patients</topic><topic>Bicarbonates</topic><topic>Carbonates</topic><topic>Chronic kidney failure</topic><topic>Health aspects</topic><topic>Measurement</topic><topic>Mortality</topic><topic>Netherlands</topic><topic>Original</topic><topic>Patient outcomes</topic><topic>Physiological aspects</topic><topic>Prognosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lombardi, Gianmarco</creatorcontrib><creatorcontrib>Chesnaye, Nicholas C</creatorcontrib><creatorcontrib>Caskey, Fergus J</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Heimburger, Olof</creatorcontrib><creatorcontrib>Pippias, Maria</creatorcontrib><creatorcontrib>Torino, Claudia</creatorcontrib><creatorcontrib>Szymczak, Maciej</creatorcontrib><creatorcontrib>Drechsler, Christiane</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Gambaro, Giovanni</creatorcontrib><creatorcontrib>Stel, Vianda S</creatorcontrib><creatorcontrib>Jager, Kitty J</creatorcontrib><creatorcontrib>Ferraro, Pietro Manuel</creatorcontrib><creatorcontrib>EQUAL study investigators</creatorcontrib><creatorcontrib>the EQUAL study investigators</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Clinical kidney journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lombardi, Gianmarco</au><au>Chesnaye, Nicholas C</au><au>Caskey, Fergus J</au><au>Dekker, Friedo W</au><au>Evans, Marie</au><au>Heimburger, Olof</au><au>Pippias, Maria</au><au>Torino, Claudia</au><au>Szymczak, Maciej</au><au>Drechsler, Christiane</au><au>Wanner, Christoph</au><au>Gambaro, Giovanni</au><au>Stel, Vianda S</au><au>Jager, Kitty J</au><au>Ferraro, Pietro Manuel</au><aucorp>EQUAL study investigators</aucorp><aucorp>the EQUAL study investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort</atitle><jtitle>Clinical kidney journal</jtitle><addtitle>Clin Kidney J</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>17</volume><issue>11</issue><spage>sfae254</spage><pages>sfae254-</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>ABSTRACT
Background
We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced chronic kidney disease (CKD) during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD) and during KRT.
Methods
Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality.
Results
We included 1485 patients with a median follow-up of 2.9 (interquartile range 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (P = .03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (P = .01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (P = .13). We observed effect modification by subjective global assessment category (P-value for interaction = .02) and KRT (P-value for interaction = .02).
Conclusions
A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.
Video Abstract
10.1093/ckj/sfae254
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6363834913112</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>39669396</pmid><doi>10.1093/ckj/sfae254</doi><orcidid>https://orcid.org/0000-0003-2298-1420</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid><orcidid>https://orcid.org/0000-0002-1379-022X</orcidid><orcidid>https://orcid.org/0000-0002-0007-1947</orcidid><orcidid>https://orcid.org/0000-0001-5733-2370</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0001-8650-5795</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical kidney journal, 2024-11, Vol.17 (11), p.sfae254 |
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| source | Oxford Journals Open Access Collection; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; SWEPUB Freely available online |
| subjects | Aged patients Bicarbonates Carbonates Chronic kidney failure Health aspects Measurement Mortality Netherlands Original Patient outcomes Physiological aspects Prognosis |
| title | Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort |
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