Sodium bicarbonate treatment achieves improvements in endothelial function in stage 3b and 4 CKD

Issue: December 2018

In patients with stage 3b or stage 4 chronic kidney disease, the use of sodium bicarbonate to treat metabolic acidosis yielded significantly improved endothelial function, according to recent findings.

In the pilot, prospective, open-label 14-week crossover study, researchers assessed 20 patients with eGFR of 15 ml/min per 1.73 m² to 44 ml/min per 1.73 m² and low serum bicarbonate levels (16 mEq/L to 21 mEq/L). Each study interval continued for 6 weeks, with a 2-week washout period in between this time. Treatment continued to a target serum bicarbonate of at least 23 mEq/L.

Researchers found that of the 18 patients who completed the study and were included in the primary efficacy analysis, a significant increase was seen in sodium bicarbonate treatment with sodium bicarbonate treatment (+2.7±2.9 mEq/L), while no change in serum bicarbonate was observed during the control interval (-0.06±2.44 mEq/L) A total of eight patients achieved the target of at least 23 mEq/L at the end of 6 weeks. Four of these eight patients achieved the goal by week 2.
Similarly, sodium bicarbonate yielded a significant improvement in FMD after 6 weeks (mean ±SD FMD at baseline: 4.1%±4.1% mean ±SD FMD at 6 weeks: 5.2%±2.9%), while the control group did not show an improvement in FMD (mean ±SD FMD at baseline: 4.6%±3.1%: mean ±SD FMD at 6 weeks: 4.1%±3.4%). Compared with the control group, patients treated with sodium bicarbonate achieved a significant increase in FMD (mean: 1.8%). Endothelium-independent vasodilation was not affected by sodium bicarbonate treatment (mean ±SD from baseline, -0.05 %±5.5). Similarly, sodium bicarbonate treatment did not yield any significant changes in serum hs-CRP, IL-6 or calcium.

A significant increase was seen in serum phosphorus and intact fibroblast growth factor-23 during treatment. –by Jennifer Byrne

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Source:

Kendrick J, et al. Clin J Am Soc Nephrol. 2018;doi:https://doi.org/10.2215/CJN.00380118.