@article{25462b4e4d194ca3bd00d945f1000bb7,
title = "Serum bicarbonate concentration and cognitive function in hypertensive adults",
abstract = "Background and objectives Cognitive function worsens as kidney function declines, but mechanisms contributing to this association are not completely understood. Metabolic acidosis, a common complication of CKD, leads to neural networks overexcitation and is involved in cerebral autoregulation. We aimed to evaluate the association between serum bicarbonate concentration as a measure of metabolic acidosis, and cognitive function in hypertensive adults with and without CKD. Design, setting, participants, & measurements Five cognitive summary scores were measured (global cognitive function, executive function, memory, attention/concentration, and language) in 2853 participants in the Systolic BP Intervention Trial (SPRINT). Multivariable linear regression models adjusted for demographics, comorbidities, systolic BP, medications, eGFR and albuminuria evaluated the cross-sectional association between bicarbonate and cognition at SPRINT baseline. In a subset (n=681) who underwent brain magnetic resonance imaging, the models were adjusted for white matter hyperintensity volume, vascular reactivity, and cerebral blood flow. Results The mean age (SD) was 68 (8.5) years. Global cognitive and executive functions were positively associated with serum bicarbonate (estimate [SEM]: 0.014 [0.006]; P=0.01, and 0.018 [0.006]; P=0.003, respectively). Each 1 mEq/L lower bicarbonate level had a similar association with global cognitive and executive function as being 4.3 and 5.4 months older, respectively. The association with global cognition persisted after magnetic resonance imaging findings adjustment (estimate [SEM]: 0.03 [0.01]; P=0.01). There was no association between serum bicarbonate level and memory, attention/concentration, and language. Conclusions In a large cohort of hypertensive adults, higher serum bicarbonate levels were independently associated with better global cognitive and executive performance. (ClinicalTrials.gov: NCT01206062).",
keywords = "Acidosis, Adult, Albuminuria, Attention, Bicarbonate, Bicarbonates, Blood pressure, Cerebrovascular circulation, Chronic, Chronic kidney disease, Cognition, Cognitive function, Cohort studies, Comorbidity, Cross-sectional studies, Demography, Executive function, Homeostasis, Humans, Language, Linear models, Magnetic resonance imaging, Memory, Renal insufficiency, White matter",
author = "{SPRINT Research Group} and Mirela Dobre and Gaussoin, {Sarah A.} and Bates, {Jeffrey T.} and Chonchol, {Michel B.} and Cohen, {Debbie L.} and Hostetter, {Thomas H.} and Raphael, {Kalani L.} and Taylor, {Addison A.} and Lerner, {Alan J.} and Wright, {Jackson T.} and Mahboob Rahman",
note = "Funding Information: The Systolic BP Intervention Trial is funded with Federal funds from the National Institutes of Health (NIH), including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute on Aging (NIA), and the National Institute of Neurological Disorders and Stroke (NINDS), under contract numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and interagency agreement number A-HL-13-002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. We also acknowledge the support from the following Clinical and Translational Science Awards funded by National Center for Advancing Translational Sciences: Case Western Reserve University: UL1TR000439, Ohio State University: UL1RR025755, University of Pennsylvania:UL1RR024134andUL1TR000003,UniversityofBoston: UL1RR025771, Stanford University: UL1TR000093, Tufts University: UL1RR025752, UL1TR000073 and UL1TR001064, University of Illinois: UL1TR000050, University of Pittsburgh: UL1TR000005, University of Texas Southwestern: 9U54TR000017-06, University of Utah: UL1TR000105-05, Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of California, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, and Tulane University: P30GM103337 Centers of Biomedical Research Excellence award National Institute of General Medical Sciences. M.D. is supported by 13FTF15920005. Funding Information: The SPRINT investigators acknowledge the contribution of study medications (azilsartan and azilsartan combined with chlorthalidone) from Takeda Pharmaceuticals International, Inc. All components of the SPRINT study protocol were designed and implemented by the investigators. The investigative team collected, analyzed, and interpreted the data. All aspects of manuscript writing and revision were carried out by the coauthors. All authors participated in data acquisition and critical revision of this manuscript. S.A.G. had had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M.D. had primary responsibility for the analytic plan. The Systolic BP Intervention Trial is funded with Federal funds from the National Institutes of Health (NIH), including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute on Aging (NIA), and the National Institute of Neurological Disorders and Stroke (NINDS), under contract numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and interagency agreement number A-HL-13-002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. We also acknowledge the support from the following Clinical and Translational Science Awards funded by National Center for Advancing Translational Sciences: Case Western Reserve University: UL1TR000439, Ohio State University: UL1RR025755, University of Pennsylvania: UL1RR024134 and UL1TR000003, University of Boston: UL1RR025771, Stanford University: UL1TR000093, Tufts University: UL1RR025752, UL1TR000073 and UL1TR001064, University of Illinois: UL1TR000050, University of Pittsburgh: UL1TR000005, University of Texas Southwestern: 9U54TR000017-06, University of Utah: UL1TR000105-05, Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of California, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, and Tulane University: P30GM103337 Centers of Biomedical Research Excellence award National Institute of General Medical Sciences. M.D. is supported by 13FTF15920005. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Centers of Biomedical Research Excellence, US Department of Veterans Affairs, or the US Government. For a full list of contributors to SPRINT, please see the supplementle acknowledgment list. Publisher Copyright: {\textcopyright} 2018 by the American Society of Nephrology.",
year = "2018",
month = apr,
day = "6",
doi = "10.2215/CJN.07050717",
language = "English (US)",
volume = "13",
pages = "596--603",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "4",
}