Contributors: Lombardi, G.; Chesnaye, N. C.; Caskey, F. J.; Dekker, F. W.; Evans, M.; Heimburger, O.; Pippias, M.; Torino, C.; Szymczak, M.; Drechsler, C.; Wanner, C.; Gambaro, G.; Stel, V. S.; Jager, K. J.; Ferraro, P. M.; Schneider, A.; Torp, A.; Iwig, B.; Perras, B.; Marx, C.; Blaser, C.; Emde, C.; Krieter, D.; Fuchs, D.; Irmler, E.; Platen, E.; Schmidt-Gürtler, H.; Schlee, H.; Naujoks, H.; Schlee, I.; Cäsar, S.; Beige, J.; Röthele, J.; Mazur, J.; Hahn, K.; Blouin, K.; Neumeier, K.; Anding-Rost, K.; Schramm, L.; Hopf, M.; Wuttke, N.; Frischmuth, N.; Ichtiaris, P.; Kirste, P.; Schulz, P.; Aign, S.; Biribauer, S.; Manan, S.; Röser, S.; Heidenreich, S.; Palm, S.; Schwedler, S.; Delrieux, S.; Renker, S.; Schättel, S.; Stephan, T.; Schmiedeke, T.; Weinreich, T.; Leimbach, T.; Stövesand, T.; Bahner, U.; Seeger, W.; Cupisti, A.; Sagliocca, A.; Ferraro, A.; Mele, A.; Naticchia, A.; Còsaro, A.; Ranghino, A.; Stucchi, A.; Pignataro, A.; De Blasio, A.; Pani, A.; Tsalouichos, A.; Antonio, B.; Di Iorio, B. R.; Alessandra, B.; Abaterusso, C.; Somma, C.; D'Alessandro, C.; Zullo, C.; Pozzi, C.; Bergamo, D.; Ciurlino, D.; Motta, D.; Russo, D.; Favaro, E.; Vigotti, F.; Ansali, F.; Conte, F.; Cianciotta, F.; Giacchino, F.; Cappellaio, F.; Pizzarelli, F.; Greco, G.; Porto, G.; Bigatti, G.; Marinangeli, G.; Cabiddu, G.; Fumagalli, G.
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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