![]() Intergroup comparisons were performed using the chi-square test, t-test, and Mann–Whitney U-test as appropriate. Normally distributed variables are presented as mean ± SD otherwise, the median and interquartile range (IQR) are presented. Data from patients who changed hospitals were considered as censored observations. The patients’ data were collected until they reached the outcome or changed hospital. We defined the outcome as a decrease of 25% or more in eGFR or starting hemodialysis or peritoneal dialysis. Serum bicarbonate level was measured by an enzymatic carbonate method using a Dimension Xpand analyzer (Siemens Healthcare Diagnostics Inc., Tokyo, Japan). Routine serum biochemistry was carried out by standard methods at Shiigai Clinic. Serum creatinine level was recorded longitudinally every month. The patients’ demographics including age, gender, and history of diabetes mellitus and hypertension laboratory variables, namely, albumin, sodium, potassium, creatinine, bicarbonate, and urinary protein levels and the use of medications, namely, renin–angiotensin–aldosterone system (RAAS) inhibitors, loop diuretics, and sodium bicarbonate were obtained from the medical records of the patients treated at the clinic. The baseline characteristics of the population were recorded at the time of the patients’ initial evaluation in the nephrology clinic. This study was approved by the Ethics Committee of Tokyo Kyosai Hospital, Tokyo, Japan. eGFR was calculated using the formula adopted by the Japanese Society of Nephrology using serum creatinine level. Serum bicarbonate level was maintained from 22 to 32 mEq/l by administration of only sodium bicarbonate. A high serum bicarbonate level was treated in accordance with K/DOQI guidelines 2000. We treated CKD as a general practice of the clinic following the CKD practice guideline of the Japanese Society of Nephrology. Patients who were treated for dementia, lung diseases, chronic heart failure, or cancer were excluded. They usually visited the Shiigai Clinic once a month. Patients were eligible for inclusion in the sample for this study when they were at least 60 years of age as of December 1st, 2009, diagnosed as having CKD on the basis of the criteria of the Japanese Society of Nephrology, had an estimated GFR (eGFR) of 60 ml/min/1.73 m 2 or lower, had never been treated by dialysis or undergone transplantation, and their serum bicarbonate levels were within the normal range (normal range, 21 to 32 mEq/l). This study was a retrospective cohort study of non-dialysis-dependent CKD patients who were treated from 2009 to 2012 at Shiigai Clinic, Ibaraki, Japan. For serum bicarbonate level to be clinically useful, in this retrospective cohort study of elderly non-dialysis-dependent CKD patients whose serum bicarbonate levels were controlled within the normal range, we evaluated the relationship between serum bicarbonate level within the normal range and CKD progression, and investigated the upper limit of the target serum bicarbonate level. There have been no confirmatory controlled trials on the therapeutic range of serum bicarbonate levels. However, the guidelines recommend only this lower limit of the target serum bicarbonate level, but no upper limit in non-dialysis-dependent CKD patients. Although elderly CKD patients have a high risk of metabolic acidosis, we were unable to find any reports about the effect of serum bicarbonate level on CKD progression in elderly CKD patients.Īt present, the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines 2000 and the Care of Australians with Renal Impairment (CARI) guidelines recommend that serum bicarbonate level should be maintained at or above 22 mEq/l. United States National Health and Nutrition Examination Surveys showed that a decreased GFR is associated with a high prevalence of acidosis in elderly CKD patients. Kidney function declines with histological changes of the kidney with aging. ![]() Intervention studies show that bicarbonate supplementation slowed the progression of kidney diseases. Observational studies showed an association between a low serum bicarbonate level and progression of kidney diseases. There is some evidence of the relationship between serum bicarbonate level and CKD progression. Metabolic acidosis leads to CKD progression. This results in net retention of hydrogen ions and metabolic acidosis. As the number of functioning nephrons decreases in chronic kidney disease (CKD), total ammonium excretion level begins to decrease when glomerular filtration rate (GFR) is below 40 to 50 mL/min/1.73 m 2. ![]()
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