Sodium bicarbonate treatment for metabolic acidosis may lower risk of CKD progression, mortality
Treating metabolic acidosis with sodium bicarbonate was associated with preserved kidney function and lower all-cause mortality rates for patients with chronic kidney disease, according to a published study.
“Metabolic acidosis is present in approximately 15% of patients with CKD and is associated with several serious consequences including risk of CKD progression, skeletal muscle catabolism, insulin resistance, bone demineralization, and mortality,” Biagio R. Di Iorio, MD, and colleagues wrote. “To mitigate these adverse consequences, clinical practice guidelines recommend treating metabolic acidosis with base supplementation. However, evidence from well-designed, large, multicenter clinical trials that treatment of metabolic acidosis with base improves bone, muscle and kidney health, or patient survival is lacking.”
For the Use of Bicarbonate in Chronic Renal Insufficiency study, researchers randomized 376 patients with CKD stages 3 to 5 to sodium bicarbonate twice daily (to achieve a target serum bicarbonate concentration of 24 mmol/l to 28 mmol/l) and 364 to standard care for 36 months. The primary endpoint of the study was the doubling or creatinine. All-cause mortality and tie to renal replacement therapy were also considered.
Researchers found 17% of participants who received standard care had doubled creatinine levels vs. 6.6% of those who took sodium bicarbonate. In addition, 6.9% of patients on sodium bicarbonate started dialysis compared with 12.3% in standard care. Regarding mortality, 6.8% of patients treated with standard care died vs. 3.1% treated with sodium bicarbonate.
Researchers noted that sodium bicarbonate had no observed effect on blood pressure, total body weight or hospitalizations.
“Correction of CKD-related metabolic acidosis preserved kidney function irrespective of gender and several other notable characteristics including the use of [renin–angiotensin–aldosterone system] RAAS inhibitors,” they wrote.– by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.