A study on effect of bicarbonate supplementation on the progression of chronic kidney disease

Alva, Suhan; Divyashree, Mithoor; Kamath, Janardhana; Prakash, Patil; Prakash, Keerthi

doi:10.4103/ijn.ijn_93_19

Cited by 16 publications

(21 citation statements)

References 27 publications

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“…There was a significant increase in serum bicarbonate levels (MD, 2.37 mEq/L; 95% CI, 1.03 to 3.72) with treatment. The average serum bicarbonate level was ≥22 mEq/L in the oral sodium bicarbonate groups, except for those in the studies by Alva et al, 28 and Witham et al 29 Overall, the analyses showed that oral sodium bicarbonate could significantly increase serum bicarbonate levels to the clinically recommended range or the KDOQI stipulations. In addition, oral sodium bicarbonate was significantly reduced in urinary ACR (MD −31.0 mg/g; 95% CI, −36.0 to −26.0) comparing with control group.…”

Section: Resultsmentioning

confidence: 79%

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Cheng¹,

Li²,

Wang³

et al. 2021

TCRM

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Objective: Oral sodium bicarbonate is often used to correct acid-base disturbance in patients with chronic kidney disease (CKD). However, there is little evidence on patientlevel benign outcomes to support the practice. Methods: We conducted a systematic review and meta-analysis to examine the efficacy and safety of oral sodium bicarbonate in CKD patients. A total of 1853 patients with chronic metabolic acidosis or those with low-normal serum bicarbonate (22-24 mEq/L) were performed to compare the efficacy and safety of oral sodium bicarbonate in patients with CKD. Results: There was a significant increase in serum bicarbonate level (MD 2.37 mEq/L; 95% CI, 1.03 to 3.72) and slowed the decline in estimated glomerular filtration rate (eGFR) (MD −4.44 mL/min per 1.73 m 2 , 95% CI, −4.92 to −3.96) compared with the control groups. The sodium bicarbonate lowered T50-time, an indicator of vascular calcification (MD −20.74 min; 95% CI, −49.55 to 8.08); however, there was no significant difference between the two groups. In addition, oral sodium bicarbonate dramatically reduced systolic blood pressure (MD −2.97 mmHg; 95% CI, −5.04 to −0.90) and diastolic blood pressure (MD −1.26 mmHg; 95% CI, −2.33 to −0.19). There were no statistically significant body weight, urine pH and mean mid-arm muscle circumference. Conclusion: Treatment of metabolic acidosis with sodium bicarbonate may slow the decline rate of kidney function and potentially significantly improve vascular endothelial function in patients with CKD. Prospero Registration Number: CRD42020207185.

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Section: Resultsmentioning

confidence: 79%

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Cheng¹,

Li²,

Wang³

et al. 2021

TCRM

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“…We found that LBM may improve in long-term studies and when baseline BMI was <27 kg/m 2 . However, due to limited number of studies evaluating LBM and their heterogeneity in LBM measurement methods: bioimpedance analysis (Kittiskulnam et al, 2020), DXA scan (Dubey et al, 2020), and equation based on corrected arm muscle area (Alva et al, 2020), our findings should be interpreted with caution in this regard. Loss of cellular protein and decreased protein content in the body, leading to muscle atrophy, increases morbidity and mortality in patients with CKD (Wang & Mitch, 2014).…”

Section: Discussionmentioning

confidence: 85%

The effects of oral sodium bicarbonate supplementation on anthropometric measures in patients with chronic kidney disease: A systematic review and meta‐analysis of randomized clinical trials

Navab,

Rouhani,

Moeinzadeh

et al. 2023

Food Science & Nutrition

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Metabolic acidosis (MA) may play a key role in the pathogenesis of protein‐energy wasting (PEW) in patients with chronic kidney disease (CKD). To present a comprehensive synthesis of the effect of oral sodium bicarbonate (SB) supplementation on anthropometric measures in patients with CKD, a systematic review was undertaken in PubMed/MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar, of relevant articles published prior to September 2022. The summary statistics of effect size, nonstandardized weighted mean difference (WMD), and 95% confidence interval (CI) were used to compare the effects of SB supplementation on anthropometric parameters vs. control group. To detect probable sources of heterogeneity, a series of predefined subgroup analyses were conducted. In total, 17 studies with 21 treatment arms, including 2203 participants (1149 cases, 1054 controls), met our inclusion criteria and were included in the meta‐analysis. SB supplementation had no significant effect on body weight (BW), midarm muscle circumference (MAMC), or lean body mass (LBM) in patients with CKD. There was a significant increase in body mass index (BMI) (MD: 0.59 kg/m2, 95% CI: 0.25 to 0.93, p = 0.001) after SB supplementation in the overall analysis. In subgroup analysis, LBM was increased in studies that were ≥ 24‐week duration (MD: 1.81 kg, 95% CI: 0.81 to 2.81) and in participants with BMI lower than 27 kg/m2 (MD: 1.81 mg/L, 95% CI: 0.81 to 2.81). SB supplementation may yield increases in BMI in predialysis CKD patients. However, our findings did not support the beneficial effects of SB supplementation on other anthropometric outcomes. There is an evident need for long‐term high‐quality interventions to confirm these findings.

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“… 28 , 30 , 31 , 32 Except for 2 trials enrolling patients with eGFR 60 to 90 with albuminuria and patients with eGFR 15 to 89 ml/min, respectively, 33 , 34 all enrolled participants had eGFR values <60 ml/min per 1.73 m 2 . Of these, 8 trials enrolled participants with CKD stages 3 or 4, 18 , 29 , 35 , 36 , 37 , 38 , 39 , 40 , 41 3 trials enrolled participants with CKD stages 4 or 5, 42 , 43 , 44 1 trial enrolled participants with CKD stages 3 to 5, 45 and 1 trial reported an inclusion criterion as serum creatinine <5 mg/dl (442 μmol/l). 46 One trial did not report an inclusion criterion based on serum bicarbonate concentration.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on Effects of Bicarbonate Therapy on Kidney Outcomes

Hultin

Hood

Campbell

et al. 2021

Kidney International Reports

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Aim Preclinical studies suggest treatment of metabolic acidosis may slow chronic kidney disease (CKD) progression. This systematic review aimed to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of bicarbonate therapy on kidney outcomes. Methods Medline, EMBASE, and Cochrane databases were searched for RCTs with ≥3 months’ follow-up in patients with CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min per 1.73 m 2 and/or proteinuria) comparing the effects of sodium bicarbonate with placebo/no study medication on kidney outcomes. The primary outcome was change from baseline to last measurement in kidney function measured as either eGFR or creatinine clearance. Treatment effects were summarized using random-effects meta-analysis. Results Fifteen trials (2445 participants, median follow-up 12 months) were eligible for inclusion. Compared with placebo or no study medication, sodium bicarbonate retarded the decline in kidney function (standardized mean difference [SMD]: 0.26; 95% confidence interval [CI]: 0.13–0.40; I 2 = 50%, low certainty evidence), and reduced the risk of end-stage kidney failure (risk ratio [RR]: 0.53; 95% CI 0.32–0.89; I 2 = 69%, low certainty evidence). The effect of sodium bicarbonate on proteinuria (SMD: −0.09; 95% CI −0.27 to 0.09; I 2 = 28%, very low certainty evidence), systolic blood pressure (weighted mean difference [WMD]: −0.57 mm Hg; 95% CI −2.32 to 1.18; I 2 = 0%, low certainty evidence), all-cause death (RR: 0.81; 95% CI: 0.39–1.68; I 2 = 30%; very low certainty evidence) and edema (RR: 1.16; 95% CI: 0.90–1.50; I 2 = 28%; low certainty evidence) were uncertain. Conclusion Sodium bicarbonate may slow CKD progression. Adequately powered randomized trials are required to evaluate the benefits and risks of sodium bicarbonate in CKD.

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A study on effect of bicarbonate supplementation on the progression of chronic kidney disease

Cited by 16 publications

References 27 publications

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

The effects of oral sodium bicarbonate supplementation on anthropometric measures in patients with chronic kidney disease: A systematic review and meta‐analysis of randomized clinical trials

A Systematic Review and Meta-Analysis on Effects of Bicarbonate Therapy on Kidney Outcomes

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