One-Year Conservative Care Using Sodium Bicarbonate Supplementation Is Associated with a Decrease in Electronegative LDL in Chronic Kidney Disease Patients: A Pilot Study

Abstract

Background: Chronic kidney disease (CKD) patients develop metabolic acidosis when approaching stages 3 and 4, a period in which accelerated atherogenesis may ensue. Studies in vitro show that low pH may increase low-density lipoprotein (LDL) oxidation, suggesting a role for chronic metabolic acidosis in atherosclerosis. The present study attempted to evaluate the effects of conservative care using oral sodium bicarbonate (NaHCO₃) supplementation on the electronegative LDL [LDL(-)], a minimally oxidized LDL, plasma levels in CKD patients. Methods: Thirty-one CKD patients were followed by a multidisciplinary team during 15 months of care in which 1.0 mmol/kg/day oral NaHCO₃ supplementation was first given in the third month. Blood samples were collected 3 months before the initiation of oral NaHCO₃ supplementation (T1), at the time of the beginning of supplementation (T2), and thereafter, each 4 months (T3, T4 and T5) until month 15 of care. Blood parameters and LDL(-) were measured from these collections. Results: After 12 months of conservative care, creatinine clearance (MDRD) was kept stable, and serum bicarbonate (HCO₃^-) increased from 20.5 ± 2.9 to 22.6 ± 1.1 m<smlcap>M</smlcap> (p < 0.003). LDL(-) plasma levels declined from 4.5 ± 3.3 to 2.1 ± 0.9 U/L (p < 0.007) after reaching mean serum HCO₃^- levels of 22.6 ± 1.1 m<smlcap>M</smlcap>. Conclusions: Conservative care using oral NaHCO₃ supplementation was able to stabilize renal function and decrease serum levels of LDL(-), a modified proatherogenic lipoprotein, only when mean serum HCO₃^- levels approached 22 m<smlcap>M</smlcap>. This study constitutes evidence that alkali therapy, in addition to its beneficial effect on renal disease progression, might serve as a preventive strategy to attenuate atherogenesis in CKD patients.

Myocardial Injury in Metabolic Acidosis of Non- Dialysis Dependent Ckd Patients.

“…There was measurably noteworthy reduction of triglyceride, absolute cholesterol and LDL-C and increment of HDL-C in treatment bunch after sodium bicarbonate treatment and this isn't concordant with [26]. Our clarification is there was increment of FT3 and FT4 in treatment bunch after sodium bicarbonate treatment.…”

“…Besides, adjustment of MA in patients with CKD causes T3 levels to ascend towards ordinary (25). Additionally, [26], reasoned that in a gathering of CKD stage 2-4 patients, the utilization of oral NaHCO3 supplementation for the remedy of MA was related with a lessening in serum levels of LDL (-), a negligibly oxidized LDL. These discoveries establish proof for a useful impact of salt treatment to forestall LDL oxidation, which has significant ramifications for atherogenesis in CKD patients [26].…”

“…Additionally, [26], reasoned that in a gathering of CKD stage 2-4 patients, the utilization of oral NaHCO3 supplementation for the remedy of MA was related with a lessening in serum levels of LDL (-), a negligibly oxidized LDL. These discoveries establish proof for a useful impact of salt treatment to forestall LDL oxidation, which has significant ramifications for atherogenesis in CKD patients [26]. In our investigation there was diminishing of LDL-C, serum uric corrosive, CRP and improvement in thyroid capacity (increment of FT3 and FT4) so as a result there was decline in endothelial brokenness, irritation and atherosclerosis.…”

The effect of sodium bicarbonate administration on renal function: A systematic review and meta-analysis of clinical trials

“…Fifty remaining studies were scrutinized in detail, and 37 articles were excluded because of: 1) using intravenous sodium bicarbonate, 2) co-supplementation of sodium bicarbonate with vitamin C, 3) using vegetables and fruits as an intervention in control group, 4) not reporting relevant data, or 5) enrolling subjects with acute kidney injury. Finally, 13 studies met all inclusion and exclusion criteria were included in this systematic review and meta-analysis (3,4,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Characteristics of the included studies are presented in Table 1. Participants were from Hong Kong, Israel, Thailand, Chinese, Brazil, Italy, South Korea, England, Thailand, and the USA.…”

“…The results of sensitivity analysis revealed that excluding the Rizetto et al study (14) attenuated bene cial effect of sodium bicarbonate on serum creatinine. This study showed a signi cant reduction in serum creatinine after sodium bicarbonate administration, however, the reported con dence interval for changes in serum creatinine was very short in this study compared with other included studies.…”