Lower bicarbonate level is associated with CKD progression and all-cause mortality: a propensity score matching analysis

BACKGROUND: Although metabolic acidosis is known as a potential complication of chronic kidney disease (CKD), there is limited information concerning the association between metabolic acidosis and clinical outcomes. METHODS: Five hundred fifty-two patients referred to renal division of Iwata City Hospital from 2015 to 2017 were included as a retrospective CKD cohort, and finally 178 patients with CKD stage III or IV and 20 to 80 years of age were analyzed. We examined the association between serum bicarbonate (HCO(3)(−)) levels and clinical outcomes using Kaplan-Meier methods after the matching of baseline characteristics by propensity scores. RESULTS: Of 178 patients with CKD, patients with lower HCO(3)(−) levels (N = 94), as compared with patients with higher HCO(3)(−) levels (N = 84), were more likely to be male (P < 0.05), had more severe CKD stages (P < 0.05), more frequent use of renin-angiotensin system inhibitor (P < 0.05) or uric acid lowering agent (P < 0.001), heavier body weight (P < 0.001) and lower estimated glomerular filtration rate (P < 0.05). In Kaplan-Meier analysis after propensity score matching, the incidence of composite outcome as the doubling of serum creatinine level from baseline, end-stage kidney disease requiring the initiation of dialysis, or death from any causes was significantly fewer in the higher HCO(3)(−) group than the lower HCO(3)(−) group (N = 57 each group, P = 0.016). CONCLUSIONS: Lower HCO(3)(−) level is significantly associated with the doubling of serum creatinine level, end-stage kidney disease or all-cause mortality in patients with CKD. TRIAL REGISTRATION: This study was registered with the Clinical Trial Registry of the University Hospital Medical Information Network (http://www.umin.ac.jp/, study number: UMIN000044861).