This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo
Clinical Summary

Does sodium bicarbonate benefit patients with CKD and mild acidosis?

Takeaway

  • Oral sodium bicarbonate did not improve physical function, increased adverse events, and had no impact on the rate of progression of chronic kidney disease (CKD) in older patients with CKD (category 4 or 5, not on dialysis) and low-grade acidosis.
  • Health economic analysis revealed that oral sodium bicarbonate was unlikely to be cost-effective for use in the UK NHS.
Why this matters
  • Current guidelines for the management of CKD recommend using oral sodium bicarbonate to treat metabolic acidosis but there is a lack of evidence in this area.

Study design

  • 300 patients with CKD with serum bicarbonate concentrations, <22 mmol/L (aged, ≥ 60 years) were randomly assigned (1:1) to receive oral sodium bicarbonate (up to 3 g/day) or placebo for up to 2 years.
  • Funding: The National Institute for Health Research Health.Technology Assessment programme.
Key results
  • At 12 months, no significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery (-0.4 points; 95% CI, -0.9 to 0.1, P=.15)
  • No significant treatment effect for glomerular filtration rate was found (0.6 mL/min/1.73 m2, 95% CI, −0.8 to 2.0; P=.39).
  • Time to commencing renal replacement therapy did not differ between groups (HR, 1.22, 95% CI, 0.74-2.02; P=.43).
  • Adverse events were more frequent in the sodium bicarbonate vs placebo group (457 vs 400).
  • Bicarbonate arm showed a lower quality of life and higher costs over 1 year (£1234 vs £807).
Limitations
  • Study included a majority of the white European population.

References


YOU MAY ALSO LIKE