Sodium Bicarbonate Lowers Phosphorus in PD Patients

SAN DIEGO—Oral sodium bicarbonate may ease hyperphosphatemia in peritoneal dialysis (PD) patients with metabolic acidosis, researchers reported at Kidney Week 2012.

Subir K. Paul, MD, and colleagues at Shoals Kidney & Hypertension Center in Florence, Ala., studied 13 PD patients with metabolic acidosis (serum bicarbonate below 22 mEq/L). Sodium bicarbonate was given orally with a total dose of 3,900 mg daily for one month. No change was made in dietary phosphate restriction.

During the treatment phase, serum bicarbonate worsened from 21.4 to 19 mEq/L in four weeks. With oral sodium bicarbonate, serum bicarbonate improved significantly from 19 to 24.9. Prior to treatment, serum phosphate rose significantly from 5.9 to 7.3 mg/dL. With treatment, it decreased significantly from 7.3 to 5.4 mg/dL. Calcium-phosphorus product increased from 54.4 to 63.7 prior to treatment, but decreased significantly from 67.7 to 50.4 after treatment. Results showed that 69% of treated patients had phosphate levels below 5.5 and calcium-phosphate product below 55, which are the target levels recommended by guidelines developed under the Kidney Disease Outcomes Quality Initiative.

The investigators concluded that oral sodium bicarbonate treatment corrects metabolic acidosis in PD patients and may be therapeutically beneficial in the management of hyperphosphatemia.

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