ORIGINAL RESEARCH article
Front. Med.
Sec. Nephrology
This article is part of the Research TopicRising Stars in Nephrology 2024: Illuminating the Future of Kidney HealthView all 5 articles
Association Between Serum Bicarbonate Levels and 28-Day In-Hospital Mortality in Dialysis Patients: A Multicenter Retrospective Cohort Study Based on the eICU Collaborative Research Database
Provisionally accepted
- 1Department of Gynecology Ward 1, Gaozhou People's Hospital, Maoming, Guangdong, China
- 2Department of Chinese Medicine and Anorectology, Fuyong People's Hospital of Baoan District, Shenzhen, Guangdong, China
- 3Department of Fuqiao Community Health Center, Fuyong People's Hospital of Baoan District, Shenzhen, Guangdong, China
- 4Epidemiology and Biostatistics, Empower U.X&Y solutions Inc, Boston, United States
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Background and Aims: The relationship between serum bicarbonate levels and 28-day mortality in dialysis patients remains unclear. This study aimed to investigate the association between serum bicarbonate levels and short-term mortality in patients undergoing dialysis. Methods: This multicenter retrospective cohort study included 4,979 dialysis patients aged 18 years or older from the electronic Intensive Care Unit (eICU) Collaborative Research Database (2014–2015). Serum bicarbonate levels were measured within 24 hours of ICU admission. A multivariate Cox regression model was applied to evaluate the association between serum bicarbonate levels and 28-day mortality. Results: A total of 4,979 patients were analyzed, with a median age of 63 years. Among them, 513 patients (10.3%) died within 28 days. A significant non-linear relationship was observed between serum bicarbonate levels and mortality. Using a two-segment linear regression model, the inflection point was determined to be 30 mmol/L (log-likelihood ratio test, p = 0.029). Below this threshold, serum bicarbonate was inversely associated with 28-day mortality (OR=0.89, 95% CI: 0.86-0.92, p <0.0001). Above the threshold, the association was not statistically significant (OR=1.11, 95% CI: 0.97-1.28, P=0.1278). Conclusion: Serum bicarbonate levels are nonlinearly associated with 28-day mortality in dialysis patients. Levels below 30 mmol/L are linked to an increased risk of death. These findings need to be confirmed in future prospective studies.
Keywords: Serum bicarbonate, Dialysis, Mortality, ICU, ESKD
Received: 07 Apr 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Wu, Wu, Liu, Zeng, Lai and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dan Wu, 15775026762@139.com
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