Using Sodium Bicarbonate in the Treatment of Chronic Kidney Disease

My critics are always voicing their critcism that there are no human studies that validate my research of alkainity in the treatment of disease.

The following published research is such a study using an alkaline mineral, sodium bicarbonate in the treatment of chronic kidney disease.

Bicarbonate supplementation may slow renal decline in chronic kidney disease

Reference: J Am Soc Nephrol, published early online 16th July 2009

Source: J Am Soc Nephrol

Date published: 20/07/2009 15:45

Summary

by: Jim Glare

A controlled trial found that giving a bicarbonate supplement to patients with chronic kidney disease (CKD) and acidosis reduced the rate of decline in renal function and improved nutritional status.

The authors note that animal evidence and short-term clinical studies suggests benefit from bicarbonate supplementation in severe renal failure, however there are no longer-term data. This study compared bicarbonate supplementation with usual care in a pre-dialysis patient population over a two-year period. Participants were adult patients with creatinine clearance (CrCl) between 15 to 30 ml/min per 1.73 m2 and serum bicarbonate 16 to 20 mmol/L, who were randomised to oral sodium bicarbonate (600mg three times daily titrated to response) or standard care. Primary end points were rate of CrCl decline, the proportion of patients with rapid decline of CrCl (>3 ml/min per 1.73 m2/yr), and end-stage renal disease (ESRD; CrCl <10 included="included" measures="measures" min="min" ml="ml" nutritional="nutritional" of="of" outcomes="outcomes" p="p" secondary="secondary" status.="status.">

A total of 184 patients was screened for eligibility over a one-year period, and 134 were randomised (20 refused consent, 30 not eligible for various reasons). Five patients in the bicarbonate group withdrew before receiving any study drug, however all were included in the intention to treat analysis. Serum bicarbonate levels increased in the bicarbonate group: they also had increased sodium excretion, but did not show significant changes in blood pressure control.

Over the course of the study, patients receiving bicarbonate had a slower decline in renal function than those in the control group, 1.88 versus 5.93 ml/min 1.73 m2 over the study period (P < 0.0001). They were less likely to have rapid decline in renal function (9% versus 45%; relative risk 0.15; 95% confidence interval 0.06 to 0.40; P < 0.0001), and fewer developed ESRD (6.5% versus 33%; relative risk 0.13; 95% confidence interval 0.04 to 0.40; P < 0.001). There were also improvements in nutritional parameters. There were no significant differences in adverse events apart from ‘bad taste’ in the bicarbonate group.

The authors conclude that in their patients with CKD, bicarbonate supplementation slowed the progression of kidney failure and improved nutritional outcomes. They discuss the study’s strengths and limitations, noting that it was carried out in a heterogeneous population representative of routine practice and had sufficient length of follow-up to observe clinically meaningful outcomes. The main weakness identified was the lack of double-blind placebo-controlled design, and they call for a multi-centre placebo-controlled trial to validate their results.

This trial has been covered by the NHS Choices ‘Behind the Headlines’ service.