A low serum bicarbonate concentration as a risk factor for mortality in peritoneal dialysis patients

PLoS One. 2013 Dec 12;8(12):e82912. doi: 10.1371/journal.pone.0082912. eCollection 2013.


Background and aim: Metabolic acidosis is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, this relationship has not yet been determined in peritoneal dialysis (PD) patients.

Methods: This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum bicarbonate (TA-Bic) levels, we aimed to investigate whether a low serum bicarbonate concentration can predict mortality in these patients.

Results: Among the baseline parameters, serum bicarbonate level was positively associated with hemoglobin level and residual glomerular filtration rate (GFR), while it was negatively associated with albumin, C-reactive protein (CRP) levels, peritoneal Kt/V urea, and normalized protein catabolic rate (nPCR) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. After adjustment for age, diabetes, coronary artery disease, serum albumin, ferritin, CRP, residual GFR, peritoneal Kt/V urea, nPCR, and percentage of lean body mass, TA-Bic level was associated with a significantly decreased risk of mortality (HR per 1 mEq/L increase, 0.83; 95% CI, 0.76-0.91; p < 0.001). In addition, compared to patients with a TA-Bic level of 24-26 mEq/L, those with a TA-Bic level < 22 and between 22-24 mEq/L conferred a 13.10- and 2.13-fold increased risk of death, respectively.

Conclusions: This study showed that a low serum bicarbonate concentration is an independent risk factor for mortality in PD patients. This relationship between low bicarbonate levels and adverse outcome could be related to enhanced inflammation and a more rapid loss of RRF associated with metabolic acidosis. Large randomized clinical trials to correct acidosis are warranted to confirm our findings.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bicarbonates / blood*
  • C-Reactive Protein / metabolism
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Peritoneal Dialysis / mortality*
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / mortality*
  • Risk Factors
  • Serum Albumin / metabolism


  • Bicarbonates
  • Serum Albumin
  • C-Reactive Protein

Grant support

This work was supported by the Brain Korea 21 Project for Medical Science, Yonsei University, by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MEST) (No. 2011-0030711), and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.