From the Guidelines
Sodium bicarbonate therapy is indicated in chronic kidney disease (CKD) patients with metabolic acidosis, typically when serum bicarbonate levels fall below 22 mEq/L, as recommended by the most recent guideline 1.
Indications for Sodium Bicarbonate Therapy
- CKD patients with serum bicarbonate concentrations < 22 mmol/l, as suggested by the KDIGO 2024 clinical practice guideline 1
- CKD stages 3-5 (eGFR <60 ml/min/1.73m²) when acidosis is present
Recommended Dosing and Monitoring
- The recommended starting dose is 650 mg (8 mEq) orally three times daily, which can be titrated up to achieve a target serum bicarbonate level of 23-29 mEq/L
- Regular monitoring of serum bicarbonate, electrolytes, and fluid status is essential to prevent adverse effects on BP control, serum potassium, or fluid status 1
Benefits and Precautions
- Sodium bicarbonate supplementation helps correct metabolic acidosis, which can slow CKD progression by reducing acid-induced kidney injury, decrease muscle protein catabolism, improve bone health by reducing bone resorption, and potentially reduce the risk of mortality
- Caution is needed in patients with fluid overload, heart failure, or hypertension due to the sodium content (each gram contains 12 mEq of sodium)
Alternative Options
- Alternative options include sodium citrate or other alkali supplements if sodium bicarbonate is not tolerated
- Treatment should be continued indefinitely as acidosis is a chronic complication of progressive kidney disease, as suggested by the KDIGO 2024 clinical practice guideline 1 and the KDOQI US commentary on the KDIGO 2024 clinical practice guideline 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Indications for Sodium Bicarbonate in CKD
- Sodium bicarbonate is used to treat metabolic acidosis in patients with chronic kidney disease (CKD) 2, 3, 4, 5, 6
- The treatment aims to correct serum bicarbonate levels and alleviate the symptoms of metabolic acidosis, which may help slow the progression of CKD 2, 3, 6
- Clinical practice guidelines suggest administering alkali to maintain serum bicarbonate levels at a minimum of 22 mEq/L to prevent the effects of acidosis on bone demineralization and protein catabolism 5
Safety and Efficacy of Sodium Bicarbonate
- Studies have shown that sodium bicarbonate therapy is safe and effective in correcting metabolic acidosis in CKD patients 2, 6
- A systematic review and meta-analysis found that sodium bicarbonate significantly increased serum bicarbonate in CKD patients, with no significant association with adverse outcomes such as death, prolonged hospitalization, or gastrointestinal disorders 2
- A randomized controlled trial found that treatment of metabolic acidosis with sodium bicarbonate delayed the progression of CKD and improved kidney and patient survival 6
Dosage and Target Serum Bicarbonate Levels
- The optimal dosage and target serum bicarbonate levels for sodium bicarbonate therapy in CKD patients are still uncertain 5
- Studies have used varying dosages and target levels, ranging from 22 mEq/L to 28 mEq/L 3, 5, 6
- Further research is needed to determine the most effective and safe dosage and target levels for sodium bicarbonate therapy in CKD patients 5