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

Abstract

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.

Chronic Kidney Disease Stage G4 in a Diabetic Patient Improved by Multi-Disciplinary Treatments Based Upon Literature Search for Therapeutic Evidence

“…Sodium bicarbonate reduced proteinuria (SMD, -0.09; 95% CI, -0.27 to 0.09). This study suggested that sodium bicarbonate may slow CKD progression [ 9 ]. Another systematic review and meta-analysis showed that oral bicarbonate supplementation resulted in a slightly higher eGFR (MD, 3.1 mL/min/1.73 m 2 ; 95% CI, 1.3 to 4.9) at the end of follow-up compared to those given placebo or conventional CKD treatment [ 10 ].…”

Kidney metabolism and acid–base control: back to the basics

“…Metabolic acidosis is common in patients with CKD, with an increasing prevalence in advanced stages of CKD. Starting in 2009, with the first open-label clinical trial, more than 10 studies have investigated the impact of alkali therapy on kidney function and CKD progression as well as proteinuria [ 55 ]. Although when comparing alkali therapy with placebo or no medication, the results were favoring sodium bicarbonate to slow CKD progression, the overall certainty of evidence is still low, and further studies are required.…”

Was ist gesichert in der Therapie der chronischen Nierenerkrankung?

“…Die KDIGO-Leitlinie zum Management von CKD empfiehlt, dass Patienten mit CKD und einer Serumbikarbonatkonzentration < 22 mmol/l eine orale Bikarbonatsubstitution erhalten und normale Serumbikarbonatkonzentrationen angestrebt werden sollten [ 3 ]. Eine kürzlich erschienene Metaanalyse zeigte, dass der Ausgleich einer metabolischen Azidose durch orale Bikarbonatsubstitution bei CKD-Patienten mit einem niedrigeren CKD-Progressions-Risiko assoziiert ist [ 21 ]. Allerdings ist die Evidenzlage insgesamt schwach.…”