Persistent High Serum Bicarbonate and the Risk of Heart Failure in Patients With Chronic Kidney Disease (CKD): A Report From the Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract Background and Aims Abnormal mineral bone metabolism of chronic kidney disease (CKD-MBD) is the most common CKD complication. However, fewer data concerning the relationship between bone metabolic indexes, such as high serum phosphorus and cardiovascular diseases, bone mass reduction, and fracture, is available in Chinese adult patients. The Chinese Chronic Renal Insufficiency Study: Based on Smartphone Platform (C-CRISS) is established to explore the relationship between bone metabolic markers and other non-traditional risk factors with renal function progression, cardiovascular (CVD), and cerebrovascular diseases (BVD), and bone loss in CKD patients. Method/design The C-CRISS study is a multi-center prospective cohort study in China. It will recruit 3360 pre-dialysis patients aged 18 to 74 years and follow up for at least two years. The individuals with CKD G3b-5ND will account for over 70 percent of the study population. Active glomerulonephritis, rapidly progressing and advanced heart, liver, and tumor diseases will be excluded. The primary composite endpoints include the events of progression to ESRD, cardiovascular events, and death. The participants will undergo the clinical evaluation at baseline and clinic visits at six-monthly intervals in traditional consultation ways. The CVD, BVD, retinopathy, DXR, and other complications will be measured annually. Data on the questionnaire, diet, quality of life, and patients’ status during follow-up will be collected by the smartphone platform developed for this study. The sample size will enable us to have 80% power to detect a 2.0 risk ratio of CVD events in CKD G4 patients compared with CKD G3a patients. Conclusion The C-CRISS study would provide evidence of the potential risk of bone metabolic markers for progressive CKD and CVD/BVD. The study will also provide a new management and complication monitoring model through smartphone communication in chronic kidney disease patients. Trial registration ClinicalTrials.gov Identifier: NCT04229485

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Resting Heart Rate and Incident Heart Failure in Patients with Chronic Kidney Disease: Analysis of the Chronic Renal Insufficiency Cohort (CRIC)

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.07.212 ◽

2017 ◽

Vol 23 (8) ◽

pp. S75

Author(s):

Sadeer G. Al-Kindi ◽

Guilherme H. Oliveira ◽

Monique R. Robinson

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Heart Rate ◽

Kidney Disease ◽

Renal Insufficiency ◽

Chronic Renal Insufficiency ◽

Resting Heart Rate ◽

Incident Heart Failure ◽

Disease Analysis

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Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study

Journal of the American Heart Association ◽

10.1161/jaha.116.005336 ◽

2017 ◽

Vol 6 (5) ◽

Cited By ~ 25

Author(s):

Jiang He ◽

Michael Shlipak ◽

Amanda Anderson ◽

Jason A. Roy ◽

Harold I. Feldman ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Renal Insufficiency ◽

Chronic Renal Insufficiency

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Serum Bicarbonate and Structural and Functional Cardiac Abnormalities in Chronic Kidney Disease - A Report from the Chronic Renal Insufficiency Cohort Study

American Journal of Nephrology ◽

10.1159/000446860 ◽

2016 ◽

Vol 43 (6) ◽

pp. 411-420 ◽

Cited By ~ 3

Author(s):

Mirela Dobre ◽

Jason Roy ◽

Kaixiang Tao ◽

Amanda H. Anderson ◽

Nisha Bansal ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Renal Insufficiency ◽

Diastolic Dysfunction ◽

Chronic Renal Insufficiency ◽

Left Ventricular ◽

Serum Bicarbonate ◽

Cardiac Abnormalities ◽

Lv Mass

Background: Heart failure (HF) is a frequent occurrence in chronic kidney disease (CKD) patients and predicts poor survival. Serum bicarbonate is associated with increased rates of HF in CKD; however, the mechanisms leading to this association are incompletely understood. This study aims to assess whether serum bicarbonate is independently associated with structural and functional cardiac abnormalities in CKD. Methods: The association between serum bicarbonate and left ventricular (LV) hypertrophy (LVH), LV mass indexed to height2.7, LV geometry, ejection fraction (EF) and diastolic dysfunction was assessed in 3,483 participants without NYHA class III/IV HF, enrolled in the Chronic Renal Insufficiency Cohort study. Results: The mean estimated glomerular filtration rate was 42.5 ± 17 ml/min/1.73 m2. The overall prevalence of LVH was 51.2%, with 57.8, 50.9 and 47.7% for bicarbonate categories <22, 22-26 and >26 mmol/l, respectively. Participants with low bicarbonate were more likely to have LVH and abnormal LV geometry (OR 1.32; 95% CI 1.07-1.64, and OR 1.57; 95% CI 1.14-2.16, respectively). However, the association was not statistically significant after adjustment for demographics, traditional cardiovascular risk factors, medications and kidney function (OR 1.07; 95% CI 0.66-1.72, and OR 1.27; 95% CI 0.64-2.51, respectively). No association was found between bicarbonate and systolic or diastolic dysfunction. During follow-up, no significant changes in LV mass or EF were observed in any bicarbonate strata. Conclusions: In a large CKD study, serum bicarbonate was associated with LV mass and concentric LVH; however, this association was attenuated after adjustment for clinical factors suggesting that the observed cardiac effects are mediated through yet unknown mechanisms.

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