From the Guidelines
KDIGO recommends oral sodium bicarbonate supplementation for patients with chronic kidney disease (CKD) who have serum bicarbonate concentrations <22 mmol/l, to maintain serum bicarbonate within the normal range, unless contraindicated (2B) 1.
Key Points
- The recommendation is specifically for patients with CKD and metabolic acidosis, defined as serum bicarbonate concentrations <22 mmol/l.
- The goal of treatment is to maintain serum bicarbonate within the normal range.
- The recommendation is based on the KDIGO Clinical Practice Guideline for the management of CKD, which aims to slow disease progression and improve patient outcomes.
Treatment Considerations
- The treatment should be individualized and titrated to achieve the target serum bicarbonate level.
- Patients should be monitored for potential side effects, including fluid retention, worsening hypertension, and edema.
- Regular monitoring of serum bicarbonate, electrolytes, and volume status is recommended during treatment.
Rationale
- Metabolic acidosis is a common complication of CKD, contributing to bone disease, muscle wasting, and accelerated disease progression.
- Sodium bicarbonate supplementation helps correct metabolic acidosis, which may slow CKD progression, improve nutritional parameters, and reduce bone turnover.
- The recommendation is based on the best available evidence, as outlined in the KDIGO guideline 1.
From the Research
KDIGO Guidelines for Sodium Bicarbonate in Chronic Kidney Disease
- The KDIGO (Kidney Disease: Improving Global Outcomes) guidelines do not explicitly mention the use of sodium bicarbonate for chronic kidney disease (CKD) in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that sodium bicarbonate may be used to treat metabolic acidosis in CKD patients, which is a common complication of the disease 2, 4, 5, 6.
Efficacy of Sodium Bicarbonate in CKD
- A study published in 2021 found that oral bicarbonate supplementation may preserve kidney function without significant increases in blood pressure and body weight 2.
- A randomized controlled trial published in 2024 found that sodium citrate and sodium bicarbonate have a similar effect on kidney function decline, but sodium bicarbonate is associated with higher rates of medication discontinuation due to adverse events 3.
- A study published in 2019 found that treatment of metabolic acidosis with sodium bicarbonate improves kidney and patient survival in CKD patients 4.
- A systematic review and meta-analysis published in 2025 found that sodium bicarbonate significantly increases serum bicarbonate in CKD patients, but does not significantly improve estimated glomerular filtration rate (eGFR) 5.
Safety Profile of Sodium Bicarbonate
- The systematic review and meta-analysis published in 2025 found that sodium bicarbonate has a favorable safety profile, with no significant association with death/prolonged hospitalization, gastrointestinal disorders, or worsening edema 5.
- A study published in 2014 found that treatment of metabolic acidosis with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate in patients with stage 3 CKD 6.