From the Guidelines
Sodium bicarbonate is prescribed in chronic kidney disease (CKD) to treat metabolic acidosis, with a goal of increasing bicarbonate levels toward but not greater than the normal range, according to the most recent guideline 1. The treatment of metabolic acidosis in CKD is crucial, as it can help prevent the progression of kidney disease and reduce the risk of complications such as bone demineralization and muscle protein breakdown.
- The typical indication for sodium bicarbonate treatment is a serum bicarbonate level less than 18 mmol/l in adults, as stated in the KDOQI commentary on the KDIGO 2024 clinical practice guideline for the evaluation and management of CKD 1.
- The dosage of sodium bicarbonate should be individualized based on the severity of acidosis and the patient's serum bicarbonate levels, with a reasonable goal of increasing bicarbonate levels toward but not greater than the normal range 1.
- Regular blood tests are necessary to assess kidney function, electrolyte levels, and acid-base status to adjust dosing appropriately, and to monitor for potential side effects such as bloating, gas, or increased blood pressure due to the sodium content 1.
- It is also important to consider the potential benefits and risks of sodium bicarbonate treatment, including the risk of worsening hypertension or fluid retention, and to monitor treatment to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal 1.
From the Research
Sodium Bicarbonate in Chronic Kidney Disease
- Sodium bicarbonate is prescribed in chronic kidney disease (CKD) to treat metabolic acidosis, a common complication of CKD that can lead to poor outcomes such as bone demineralization, muscle mass loss, and worsening of renal function 2.
- The treatment of metabolic acidosis with sodium bicarbonate has been shown to improve kidney function and patient survival in CKD patients 3.
- Sodium bicarbonate therapy has been found to increase serum bicarbonate levels, slow the decline in estimated glomerular filtration rate (eGFR), and reduce the risk of dialysis and death in CKD patients 3, 4.
- The use of sodium bicarbonate in CKD patients has also been associated with improved vascular endothelial function, increased muscle mass, and preserved kidney function 5, 4.
- However, sodium bicarbonate therapy may be associated with higher rates of medication discontinuation due to adverse events compared to other treatments, such as sodium citrate 6.
Mechanism of Action
- Sodium bicarbonate works by increasing serum bicarbonate levels, which helps to neutralize acid and reduce the burden on the kidneys 2.
- The correction of metabolic acidosis with sodium bicarbonate has been shown to slow the decline in kidney function and improve patient outcomes in CKD patients 3, 4.
Clinical Evidence
- Several clinical trials have demonstrated the efficacy and safety of sodium bicarbonate therapy in CKD patients, including the UBI Study 3 and a systematic review and meta-analysis 4.
- These studies have shown that sodium bicarbonate therapy can improve kidney function, reduce the risk of dialysis and death, and improve vascular endothelial function in CKD patients 3, 4.