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New research · Nephrology
Kidney medicine · 4d
Cohort studyKidney medicine · 2026

Trajectories of Serum Total Carbon Dioxide and the Risk of Cardiorenal Outcomes in Chronic Kidney Disease: Results From the KNOW-CKD Study.

Semin Cho, Wookyung Chung, Young Youl Hyun … Ji Yong Jung
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NephrologyCohort study

Persistent low serum total carbon dioxide is associated with a higher hazard of renal events.

Trajectories of Serum Total Carbon Dioxide and the Risk of Cardiorenal Outcomes in Chronic Kidney Disease: Results From the KNOW-CKD Study.

Semin Cho … Ji Yong Jung
Kidney medicine · 2026
Background

Serum bicarbonate concentrations vary over time in chronic kidney disease (chronic kidney disease), but most studies have focused on baseline values rather than longitudinal trajectories.

Purpose

We aimed to determine the association between long-term patterns of serum total carbon dioxide (tCO 2 ) and adverse renal and cardiovascular outcomes.

Methods

With chronic kidney disease enrolled in a prospective cohort with repeated tCO 2 measurements.

HR, 2.08
Results
HR, 2.08
Persistently low blood carbon dioxide more than doubled the risk of kidney problems
More results

The High trajectory group showed a trend toward lower renal risk (HR, 0.57; 95% CI, 0.31-1.03), with time-dependent protective effects during prolonged follow-up.

The Improving group showed no significant differences in renal or cardiovascular risk but demonstrated a numerically lower incidence of the renal endpoint.

More results

Cardiovascular outcomes did not differ across trajectories.

LIMITATIONS: Observational design and potential residual confounding.

“
Conclusion · 1 of 2

Persistent low tCO 2 was associated with increased renal risk, whereas high levels conferred delayed protection. The Improving group showed intermediate risk.

Conclusion · 2 of 2

Longitudinal monitoring of tCO 2 may help guide individualized bicarbonate therapy in chronic kidney disease.

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