Evidence map›Paper›PMID 25896890›Full record

ArticleJournal of the American Heart Association2015

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.

Mirela Dobre, Wei Yang, Qiang Pan, Lawrence Appel, Keith Bellovich, Jing Chen, Harold Feldman, Michael J Fischer, L L Ham, Thomas Hostetter and 7 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 2 pooled it
5.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 89 citations in OpenAlex.

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  4. Serum bicarbonate and cardiovascular events in hypertensive adults: results from the Systolic Blood Pressure Intervention Trial.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 9 institutions in 1 country.

Mirela DobreDivision of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.).
Wei YangCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).
Qiang PanCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).
Lawrence AppelDepartment of Medicine, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Epidemiology, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.).
Keith BellovichSt. John Hospital and Medical Center Detroit, MI (K.B.).
Jing ChenSection of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., H.).
Harold FeldmanCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (W.Y., Q.P., H.F.).
Michael J FischerJesse Brown VAMC and University of Illinois Hospital and Health Sciences System, Chicago, IL (M.J.F.).
L L HamSection of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., H.).
Thomas HostetterDivision of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.).
Bernard G JaarDepartment of Medicine, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Epidemiology, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.) Department of Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.A., B.G.J.).
Radhakrishna R KallemRenal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (R.R.K.).
Sylvia E RosasJoslin Diabetes Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.).
Julia J SciallaDuke University School of Medicine, Durham, NC (J.J.S.).
Myles WolfDivision of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL (M.W.).
Mahboob RahmanDivision of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, OH (M.D., T.H., M.R.) Louis Stokes Cleveland VA Medical Center, Cleveland, OH (M.R.).
CRIC Study Investigators
University of Pennsylvania · USCase Western Reserve University · USJohns Hopkins University · USTulane University · USBeth Israel Deaconess Medical Center · USDuke University · USNorthwestern University · USSt. John Hospital & Medical Center · USUniversity of Illinois Hospital & Health Sciences System · US

Funding

UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
Scientific and Data Coordinating Center(SDCC) for the P*U01DK060990 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI FELDMAN, HAROLD I · 2001 to 2017
$50.1M
Clinical and Translational Science Collaborative of ClevelandUL1TR000439 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI KONSTAN, MICHAEL W. · 2012 to 2016
$50.0M
Michigan Institute for Clinical and Health Research (MCHR)UL1TR000433 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MASHOUR, GEORGE ALEXANDER · 2012 to 2016
$49.9M
Institutional Clinical and Translational Science AwardUL1TR000003 · NCATS · UNIVERSITY OF PENNSYLVANIA · PI FITZGERALD, GARRET A · 2012 to 2015
$38.9M
Zonulin Antibodies in Intestinal Permeabilitiy in IDDMM01RR016500 · NCRR · UNIVERSITY OF MARYLAND BALTIMORE · PI OSWALD, LYNN M · 2002 to 2009
$20.2M
Study of the Care and Outcomes of REnal InsufficiencyU01DK060902 · NIDDK · KAISER FOUNDATION RESEARCH INSTITUTE · PI GO, ALAN S · 2001 to 2025
$19.5M
Limited Competition for the Continuation of the Chronic Renal Insufficiency CohorU01DK061021 · NIDDK · CASE WESTERN RESERVE UNIVERSITY · PI RAHMAN, MAHBOOB · 2001 to 2025
$17.3M
Prospective Renal Insufficiency Cohort Evaluation:PRICEU01DK060984 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI COHEN, DEBBIE L · 2001 to 2025
$17.0M
Prospective Cohort Study of Chronic Renal InsufficiencyU01DK061028 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI RAO, PANDURANGA S · 2001 to 2025
$16.9M
Limited Competition for the Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Hopkins Clinical CenterU01DK061022 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI APPEL, LAWRENCE JOHN · 2001 to 2025
$15.7M
Proposal for a Chicago-CRIC Clinical CenterU01DK060980 · NIDDK · UNIVERSITY OF ILLINOIS AT CHICAGO · PI LASH, JAMES P. · 2001 to 2025
$15.4M
NCATS NIH HHS UL1 TR000003NCATS NIH HHS UL1TR000003NCATS NIH HHS UL1 TR-000424NCATS NIH HHS UL1 TR000433NCATS NIH HHS UL1TR000433NCATS NIH HHS UL1 TR000439NCATS NIH HHS UL1TR000439NCRR NIH HHS M01 RR-16500NCRR NIH HHS UL1 RR-024131NCRR NIH HHS UL1 RR029879NCRR NIH HHS UL1RR029879NIDDK NIH HHS K23 DK095949NIDDK NIH HHS K23DK095949NIDDK NIH HHS K24 DK093723NIDDK NIH HHS R01 DK081374NIDDK NIH HHS R01DK081374NIDDK NIH HHS R01 DK139225NIDDK NIH HHS U01 DK060902NIDDK NIH HHS U01DK060902NIDDK NIH HHS U01 DK060963NIDDK NIH HHS U01DK060963NIDDK NIH HHS U01 DK060980NIDDK NIH HHS U01DK060980NIDDK NIH HHS U01 DK060984NIDDK NIH HHS U01DK060984NIDDK NIH HHS U01 DK060990NIDDK NIH HHS U01DK060990NIDDK NIH HHS U01 DK061021NIDDK NIH HHS U01DK061021NIDDK NIH HHS U01 DK061022NIDDK NIH HHS U01DK061022NIDDK NIH HHS U01 DK061028NIDDK NIH HHS U01DK061028NIGMS NIH HHS P30 GM103337NIGMS NIH HHS P30GM103337
6 · The paper itself

Abstract

backgroundSerum bicarbonate varies over time in chronic kidney disease (CKD) patients, and this variability may portend poor cardiovascular outcomes. The aim of this study was to conduct a time-updated longitudinal analysis to evaluate the association of serum bicarbonate with long-term clinical outcomes: heart failure, atherosclerotic events, renal events (halving of estimated glomerular filtration rate [eGFR] or end-stage renal disease), and mortality. METHODS AND

resultsSerum bicarbonate was measured annually, in 3586 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. Marginal structural models were created to allow for integration of all available bicarbonate measurements and proper adjustment for time-dependent confounding. During the 6 years follow-up, 512 participants developed congestive heart failure (26/1000 person-years) and 749 developed renal events (37/1000 person-years). The risk of heart failure and death was significantly higher for participants who maintained serum bicarbonate >26 mmol/L for the entire duration of follow-up (hazard ratio [HR] 1.66; 95% confidence interval [CI], 1.23 to 2.23, and HR 1.36, 95% CI 1.02 to 1.82, respectively) compared with participants who kept their bicarbonate 22 to 26 mmol/L, after adjusting for demographics, co-morbidities, medications including diuretics, eGFR, and proteinuria. Participants who maintained serum bicarbonate <22 mmol/L had almost a 2-fold increased risk of renal disease progression (HR 1.97; 95% CI, 1.50 to 2.57) compared with participants with bicarbonate 22 to 26 mmol/L.

conclusionIn this large CKD cohort, persistent serum bicarbonate >26 mmol/L was associated with increased risk of heart failure events and mortality. Further studies are needed to determine the optimal range of serum bicarbonate in CKD to prevent adverse clinical outcomes.

Indexed as

BicarbonatesDisease ProgressionDiureticsFemaleGlomerular Filtration RateHeart FailureHumansLongitudinal StudiesMaleMiddle AgedRenal Insufficiency, ChronicRisk FactorsBicarbonatesDiureticsCKDheart failureserum bicarbonate

Identifiers

PMID25896890
PMCPMC4579944
OpenAlexW2165304796

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.