Therapeutics and Clinical Risk Management (Dec 2021)
The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis
Abstract
Fang Cheng,1,2 Qiang Li,1,2 Jinglin Wang,1,2 Zhendi Wang,3 Fang Zeng,1,2 Yu Zhang1,2 1Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, People’s Republic of China; 3Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of ChinaCorrespondence: Fang Zeng; Yu ZhangDepartment of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of ChinaEmail [email protected]; [email protected]: Oral sodium bicarbonate is often used to correct acid-base disturbance in patients with chronic kidney disease (CKD). However, there is little evidence on patient-level benign outcomes to support the practice.Methods: We conducted a systematic review and meta-analysis to examine the efficacy and safety of oral sodium bicarbonate in CKD patients. A total of 1853 patients with chronic metabolic acidosis or those with low-normal serum bicarbonate (22– 24 mEq/L) were performed to compare the efficacy and safety of oral sodium bicarbonate in patients with CKD.Results: There was a significant increase in serum bicarbonate level (MD 2.37 mEq/L; 95% CI, 1.03 to 3.72) and slowed the decline in estimated glomerular filtration rate (eGFR) (MD − 4.44 mL/min per 1.73 m2, 95% CI, − 4.92 to − 3.96) compared with the control groups. The sodium bicarbonate lowered T50-time, an indicator of vascular calcification (MD − 20.74 min; 95% CI, − 49.55 to 8.08); however, there was no significant difference between the two groups. In addition, oral sodium bicarbonate dramatically reduced systolic blood pressure (MD − 2.97 mmHg; 95% CI, − 5.04 to − 0.90) and diastolic blood pressure (MD − 1.26 mmHg; 95% CI, − 2.33 to − 0.19). There were no statistically significant body weight, urine pH and mean mid-arm muscle circumference.Conclusion: Treatment of metabolic acidosis with sodium bicarbonate may slow the decline rate of kidney function and potentially significantly improve vascular endothelial function in patients with CKD.Prospero Registration Number: CRD42020207185.Keywords: chronic kidney disease, metabolic acidosis, sodium bicarbonate, kidney function, cardiovascular risk
