High-dose sodium bicarbonate effective in CKD but may increase urinary albumin excretion
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Published findings suggest that, for patients with chronic kidney disease, a higher dose of sodium bicarbonate lowered urinary ammonium excretion and increased serum bicarbonate more than a lower dose. However, the higher dose was associated with a greater increase in urinary albumin excretion.
“Results from studies with small sample sizes suggested that treating metabolic acidosis slowed kidney function decline,” Kalani L. Raphael, MD, MS, of the University of Utah, and colleagues wrote. “Further, results from studies in hypertensive CKD support the hypothesis that alkali supplementation may preserve kidney function even in patients with normal serum bicarbonate concentrations. This nding is potentially important because most patients with CKD do not have overt metabolic acidosis and are not treated with oral alkali based on current practice standards. These observations raise the possibility that alkali supplementation may benet the broader CKD population.”
To assess the effect of oral alkali supplementation on CKD progression, as well as on patient safety, researchers conducted the Bicarbonate Administration to Stabilize eGFR (BASE) Pilot Trial, in which they administered a high (0.8 meq/kg of lean body weight per day) or low dose (0.5 meq/kg) of oral sodium bicarbonate to 194 patients with CKD (baseline eGFR, 36 mL/min/1.73m2; mean serum bicarbonate, 24 meq/L; median albumin-to-creatinine ratio, 181 mg/g). Placebo was administered to 52 participants.
During a 28-week period, researchers found mean urinary ammonium excretion was 25% lower in patients taking the high dose of sodium bicarbonate compared with the lower dose. In addition, serum bicarbonate concentration was 1.3 meq/L higher with the high dose.
However, while mean ACR increased by 12% in the lower-dose group, it increased by 30% in the higher-dose group.
Regarding safety, they observed that both doses were well tolerated and that both groups had similar proportions of adverse events and hospitalizations compared with placebo.
“The pharmacodynamic prole, based on changes in urinary ammonium and serum bicarbonate concentration, appears to favor using the higher dose in future full-scale trials,” the researchers concluded. “However, the favorable prole of the higher dose is counterbalanced by an unexpected, modest increase in ACR. These findings provide critical preliminary data to help guide dose selection in future clinical trials evaluating the effect of [sodium bicarbonate] NaHCO3 on CKD progression.” – by Melissa J. Webb
Disclosures: Raphael reports receiving grants from NIDDK/NIH and VA. Please see the study for all other authors’ relevant financial disclosures.
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