Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney Disease with Metabolic Acidosis: A Meta-Analysis
A meta-analysis of 14 randomized trials found that oral sodium bicarbonate modestly improved kidney function and muscle mass in CKD patients with metabolic acidosis, but was associated with higher systolic blood pressure.
Background
In CKD, impaired kidney acid excretion leads to metabolic acidosis, but the evidence on whether sodium bicarbonate supplementation improves clinical outcomes has been inconclusive.
Study design
Systematic review and meta-analysis of randomized controlled trials (PubMed, Embase, Cochrane through November 2023) of sodium bicarbonate in CKD with metabolic acidosis; the primary outcome was change in eGFR, with secondary outcomes of hospitalization, systolic BP, mortality, and muscle mass.
Key findings
Fourteen RCTs (2,037 patients): eGFR improved (SMD 0.33, 95% CI 0.03-0.63); hospitalization was lower (OR 0.37, 0.25-0.55); mid-arm muscle circumference was higher (SMD 0.23); systolic BP was higher (SMD 0.10); no significant difference in all-cause mortality.
Clinical implications
Sodium bicarbonate may help preserve kidney function and muscle mass in CKD with metabolic acidosis but can raise blood pressure. Findings should be interpreted cautiously given the risk of bias from mostly non-blinded trials and inconsistent control-group definitions.
Category
Research
Source
Clinical Journal of the American Society of Nephrology
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