From the Guidelines
Sodium bicarbonate (NaHCO3) is recommended for patients with Chronic Kidney Disease (CKD) and serum bicarbonate levels below 22 mmol/L to maintain levels within the normal range, unless contraindicated, as it helps slow CKD progression and improves quality of life. The treatment goal is to maintain serum bicarbonate levels between 22-26 mmol/L, with a target range of 24-26 mmol/L for adults with CKD 3-5D 1. Oral sodium bicarbonate supplementation is the preferred method, with a typical starting dose of 650 mg (8 mEq) orally 1-3 times daily, which can be titrated upward based on regular bicarbonate level monitoring 1.
Some key points to consider when using sodium bicarbonate in CKD patients include:
- Monitoring blood pressure and fluid status, particularly in patients with heart failure or severe hypertension, due to the risk of sodium retention and edema 1
- Considering sodium citrate as an alternative for patients who cannot tolerate the sodium load from bicarbonate therapy 1
- Regularly monitoring serum bicarbonate levels to adjust the dose and maintain target levels 1
- Being aware of the potential benefits of sodium bicarbonate supplementation, including slowing CKD progression, reducing kidney fibrosis and inflammation, preserving muscle mass, improving bone health, and enhancing overall quality of life 1
The most recent and highest quality study, published in 2020, recommends reducing net acid production through increased bicarbonate or citric acid/sodium citrate solution supplementation to reduce the rate of decline of residual kidney function in adults with CKD 3-5D 1. This study supports the use of sodium bicarbonate in CKD patients and provides guidance on the target serum bicarbonate levels and dosing.
From the Research
Role of Sodium Bicarbonate in Managing Metabolic Acidosis in CKD Patients
- Sodium bicarbonate (NaHCO3) is used to manage metabolic acidosis in patients with Chronic Kidney Disease (CKD) 2, 3, 4, 5, 6.
- The administration of sodium bicarbonate in non-dialysed CKD patients improves parameters of metabolic acidosis and serum nutritional markers 2.
- Sodium bicarbonate supplementation does not significantly increase blood pressure measured by 24-hour ambulatory blood pressure monitoring (24h-ABPM) in CKD patients 3.
- Correction of metabolic acidosis with sodium bicarbonate may have beneficial effects on protein and bone metabolism in CKD patients 4.
- Sodium bicarbonate therapy may halt worsening kidney function by correcting serum bicarbonate levels and treating metabolic acidosis, while maintaining an overall favorable safety profile 5.
Comparison with Other Treatments
- Sodium citrate and sodium bicarbonate have a similar effect on kidney function decline and improve serum bicarbonate levels in CKD patients 6.
- However, sodium bicarbonate is associated with higher rates of medication discontinuation due to adverse events compared to sodium citrate 6.
Effects on Kidney Function and Metabolic Acidosis
- Sodium bicarbonate significantly increases serum bicarbonate in CKD patients 2, 5.
- There is no significant difference in the effect of sodium bicarbonate on estimated glomerular filtration rate (eGFR) in CKD patients 2, 5, 6.
- Sodium bicarbonate may reduce the risk of hospitalization and slow the progression of CKD 4, 5.