Relationship of acid-base status with arterial stiffness in community-living elders: the Health ABC Study

Background: Animal studies suggest that acidosis protects against arterial calcification, which contributes to arterial stiffness. The goal of this study was to investigate the associations of serum bicarbonate and pH with arterial stiffness in community-living older adults. Methods: We performed cross-sectional analyses among 1698 well-functioning participants 70-79 years of age. Bicarbonate and pH were measured by arterialized venous blood gas at the point of care. Bicarbonate was categorized into low (<23 mEq/L), normal (23-27.9) and high (≥28). Arterialized venous pH (AVpH) was categorized into tertiles: ≤7.40, >7.40-7.42 and >7.42. Arterial stiffness was evaluated by pulse wave velocity (PWV) and high ankle-brachial index (ABI; >1.3/incompressible). We used linear and logistic regression to evaluate the association of bicarbonate and AVpH with PWV and high ABI, respectively. Results: The mean age was 76 years and 15% had an estimated glomerular filtration rate (eGFR)  <60 mL/min/1.73 m2. The mean bicarbonate was 25.2 ± 2.1 mEq/L and the mean AVpH was 7.41 ± 0.03. Compared with participants in the normal bicarbonate category, those in the low bicarbonate group had 8.8% higher PWV (P = 0.006) and 1.87 greater odds of high ABI (P = 0.04). However, the associations were not significant after adjusting for eGFR (P = 0.24 and 0.43, respectively). There was no difference in PWV or high ABI across AVpH tertiles. Results were similar in those with and without chronic kidney disease and after excluding participants on diuretics. Conclusions: We did not observe an independent association of bicarbonate or AVpH with arterial stiffness measured by high PWV or ABI in community-living older individuals. Future studies evaluating patients with a greater severity of chronic kidney disease and with more extreme alterations in acid-base status are warranted.