What is the effect of bicarbonate supplementation on renal function in chronic kidney disease (CKD)?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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De Brito-Ashurst et al found that patients with CKD who receive bicarbonate supplementation show a slower decline in renal function. [84] In this study, 134 adult patients with CKD (ie, creatinine clearance [CrCl], 15-30 mL/min/1.73 m2; serum bicarbonate, 16-20 mmol/L) were randomly assigned to receive oral sodium bicarbonate supplementation or standard care for 2 years. A slower decline in CrCl was observed in the bicarbonate group (1.88 mL/min/1.73 m2) than in the control group (5.93 mL/min/1.73 m2). [84]

Patients in the bicarbonate group were also less likely to experience rapid disease progression (9%) than were members of the control group (45%), and fewer patients who received bicarbonate supplementation developed ESRD than did controls (6.5% vs 33%, respectively). [84] In addition, nutritional parameters improved with bicarbonate supplementation.

Correction of acidosis with sodium bicarbonate was associated with significantly slower progression of CKD in the randomized, unblinded Use of Bicarbonate in Chronic Renal Insufficiency (UBI) trial. All 740 patients in UBI, most of whom had stage 3b or 4 CKD, received standard care; the 376 patients in the treatment group also received sodium bicarbonate. Achieving target serum bicarbonate levels (24-28 mmol/L) required an average of about 6 g/day of sodium bicarbonate—an admittedly significant pill burden of four to seven pills twice daily. [85]

At a mean follow-up of 32.9 months, serum creatinine had doubled in 25 patients in the treatment group and 62 patients in the control group (hazard ratio [HR], 0.36; P < 0.001). Dialysis had been initiated in 26 treatment group versus 45 control patients (HR, 0.5; P = 0.005), and death from any cause had occurred in 25 vs 12 patients, respectively (HR, 0.43; P = 0.01). Patients in the treatment group also showed a trend toward fewer hospitalizations. Fluid overload, uncontrolled blood pressure, and other unwanted effects were not seen in the treatment group. [85]

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