Abstract
Metabolic acidosis is common in chronic kidney disease (CKD) and may have various deleterious consequences. Arterial stiffness in CKD patients is associated with poor cardiovascular outcomes. The present study aimed to evaluate the association between serum bicarbonate and arterial stiffness using the baseline cross-sectional data set of a large-scale Korean CKD cohort. 2,238 CKD patients were enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. The present study was conducted on 1,659 patients included in this cohort with baseline serum bicarbonate and brachial-to-ankle pulse wave velocity (baPWV) data. Metabolic acidosis was defined as a serum bicarbonate level of <22 mmol/L, and baPWV was used as a surrogate of arterial stiffness. Mean serum bicarbonate was 25.8 ± 3.6 mmol/L. 210 (12.7%) patients had metabolic acidosis. baPWV was significantly higher in patients with metabolic acidosis (P < 0.001) and showed a significant inverse correlation with serum bicarbonate (Unstandardized β −16.0 cm/sec; 95% CI −20.5, −11.4; P < 0.001) in an unadjusted model, which was retained after adjustment (Unstandardized β −5.4 cm/sec; 95% CI −9.9, −1.0; P = 0.017). Metabolic acidosis was found to be associated with a high baPWV in pre-dialysis CKD patients.
Highlights
The kidney plays a major role in the maintenance of systemic acid-base balance, but the ability of the kidney to excrete ammonium or reabsorb bicarbonate in response to daily acid load is impaired in chronic kidney disease (CKD)[1,2,3]
The prevalence of metabolic acidosis depends on the definition used, for example, when metabolic acidosis was defined as a serum bicarbonate concentration of
The present study was undertaken to investigate the association between metabolic acidosis and arterial stiffness using serum bicarbonate levels and brachial-ankle Pulse wave velocity (PWV) (baPWV) as surrogates, respectively, using the baseline data set of a large-scale Korean CKD cohort
Summary
The kidney plays a major role in the maintenance of systemic acid-base balance, but the ability of the kidney to excrete ammonium or reabsorb bicarbonate in response to daily acid load is impaired in chronic kidney disease (CKD)[1,2,3]. In CKD patients, a number of factors such as age, physical inactivity, smoking, hypertension, hyperglycemia, hyperphosphatemia, and chronic inflammation can accelerate vascular calcification, which is a major mediator of arterial stiffness[7]. Inflammation and insulin resistance, which are the adverse consequences of metabolic acidosis, may cause arteriosclerosis[17]. These observations suggest metabolic acidosis and arterial stiffness may be closely related, but few have investigated the link between metabolic acidosis and arterial stiffness in CKD patients. The present study was undertaken to investigate the association between metabolic acidosis and arterial stiffness using serum bicarbonate levels and baPWV as surrogates, respectively, using the baseline data set of a large-scale Korean CKD cohort
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