Sodium bicarbonate treatment of metabolic acidosis in patients with chronic kidney disease (CKD) improves renal outcomes and survival, researchers reported at the 56th European Renal Association-European Dialysis and Transplant Association Congress in Budapest, Hungary.

In a prospective open-label study, patients with CKD and metabolic acidosis who took sodium bicarbonate (SB) tablets were less likely to experience a doubling of serum creatinine (the study’s primary end point), initiate renal replacement therapy (RRT, and death than those who received standard care (SC).

For the study, Antonio Bellasi, MD, PhD, of ASST Papa Giovanni XXIII in Bergamo, Italy, and colleagues randomly assigned 740 patients with CKD and metabolic acidosis to receive SB (376 patients) or standard care (SC, 364 patients). The study population had a mean age of 67.8 years, mean creatinine clearance of 30 mL/min, and mean serum bicarbonate level of 21.5 mmol/L. The mean follow-up duration was 30.3 and 29.6 months, respectively. The mean daily dose of SB as 1.13, 1.12, and 1.09 mmol/kg of body weight in the first, second, and third year of follow-up, respectively.

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Overall, 87 patients reached the primary end point: 25 (6.6%) in the SB group and 62 (17%) in the SC group. The SB group had a significant 64% lower risk of a doubling of serum creatinine compared with the SC group, Dr Bellasi’s team reported.

At the end of the study, 26 patients (6.9%) in the SB group and 71 (12.3%) in the SC group had initiated RRT. The SB group had a significant 50% decreased risk of RRT initiation compared with the SC group.

Lastly, 12 patients (3.1%) in the SB group and 25 (6.8%) in the SC group died. Compared with the SC group, the SB group had a 57% decreased risk of death, according to the investigators.

SB had no significant effect on hospitalizations, blood pressure, or total body weight.

Separately, a systematic review and meta-analysis of the effect of treatment of metabolic acidosis in CKD published online June 13 in the Clinical Journal of the American Society of Nephrology concluded that “current clinical trial evidence suggests that oral alkali supplementation or a reduction of dietary acid load improved serum bicarbonate levels and may slow the progression of kidney disease, on the basis of very-low- to moderate-certainty clinical evidence.” The review, by Sankar D. Navaneethan, MD, of the Baylor College of Medicine in Houston, included 14 clinical trials enrolling a total of 1394 participants.

References

Bellasi A, Raphael K, Santoro D, et al. Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: The UBI study. Presented at the 56th European Renal Association-European Dialysis and Transplant Association Congress in Budapest, Hungary.