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Diseases 2016, 4(4), 36; doi:10.3390/diseases4040036

Association between Low Serum Bicarbonate Concentrations and Cardiovascular Disease in Patients in the End-Stage of Renal Disease

1
1st Department of Medicine—Propaedaetic, School of Medicine, National & Kapodistrian University of Athens, Athens 11527, Greece
2
Department of Nuclear Medicine, General Hospital “LAΪKO”, Athens 11527, Greece
*
Author to whom correspondence should be addressed.
Academic Editor: Chim C. Lang
Received: 21 August 2016 / Revised: 21 October 2016 / Accepted: 7 November 2016 / Published: 15 November 2016
(This article belongs to the Section Cardiology)
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Abstract

Background: Metabolic acidosis, a common condition particularly in the end-stage of renal disease patients, results in malnutrition, inflammation and oxidative stress. In this study, we focused on the association between low serum bicarbonate and cardiovascular disease in patients on intermittent dialysis. Methods: We studied 52 on-line-pre-dilution hemodiafiltration (on-l HDF) patients, 32 males and 20 females, with a mean age of 58.01 ± 15.4 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22 mmol/L. Residual renal function (RRF) was defined by interdialytic urine volume. Kaplan–Meier curves and Cox regression models were performed to predict coronary artery disease (CAD), defined by ejection fraction <50%, or diastolic dysfunction congestive heart failure (CHF) and peripheral vascular disease (PVD). Results: Kaplan–Meier analyses showed that a lower or higher than 22 mmol/L serum bicarbonate metabolic acidosis status was significantly associated with both PVD and diastolic dysfunction (log-rank = 5.07, p = 0.02 and log-rank = 5.84, p = 0.01, respectively). A similar prevalence of serum bicarbonate on CAD or CHF by low ejection fraction was not shown. The RRF was associated with PVD event and serum bicarbonate less than 22 mmol/L (log-rank = 5.49, p = 0.01 and log-rank = 3.9, p = 0.04, respectively). Cox regression analysis revealed that serum bicarbonate and RRF were significant risk factors for PVD after adjustment for confounders. Furthermore, RRF adjusted for covariates was shown to be a significant risk factor for diastolic dysfunction. Conclusion: Low serum bicarbonate was associated with peripheral vascular disease and diastolic dysfunction in intermittent dialysis. The residual renal function may impact patients’ outcomes through its relationship with metabolic acidosis status, particularly for peripheral vascular disease manifestation. View Full-Text
Keywords: hemodialysis; inflammation; metabolic acidosis; cardiovascular disease; lipoprotein oxidation; residual renal function hemodialysis; inflammation; metabolic acidosis; cardiovascular disease; lipoprotein oxidation; residual renal function
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MDPI and ACS Style

Raikou, V.D.; Kyriaki, D. Association between Low Serum Bicarbonate Concentrations and Cardiovascular Disease in Patients in the End-Stage of Renal Disease. Diseases 2016, 4, 36.

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