From the Guidelines
Bicarbonate is administered to patients with End-Stage Renal Disease (ESRD) to treat metabolic acidosis, with a goal of maintaining serum bicarbonate levels between 22-26 mEq/L, as recommended by the most recent guideline evidence 1. The standard approach is to prescribe oral sodium bicarbonate tablets, with dosage adjustments based on serum bicarbonate levels.
- The dosage of oral sodium bicarbonate can be adjusted to achieve the target serum bicarbonate level, with a typical starting dose of 650 mg to 1300 mg (8-15 mEq) three times daily.
- During dialysis, the dialysate solution also contains bicarbonate (typically 35-40 mEq/L) to help correct acidosis.
- Treating metabolic acidosis in ESRD patients is crucial because chronic acidosis can lead to bone demineralization, muscle wasting, protein catabolism, inflammation, and increased mortality.
- Additionally, correcting acidosis may slow the progression of kidney disease in patients with residual renal function, improve nutritional status, and reduce complications like hyperkalemia.
- Patients should be monitored regularly for their bicarbonate levels, and dosages should be adjusted accordingly to avoid overcorrection, which could lead to metabolic alkalosis, as suggested by previous studies 1. However, the most recent guideline evidence 1 suggests that acidosis in adults should only be treated with pharmacologic agents when bicarbonate < 18 mmol/l or if there is a clear indication to do so, and a reasonable goal would be to increase bicarbonate levels toward but not greater than the normal range with sodium bicarbonate or other agents.
From the FDA Drug Label
Sodium Bicarbonate Injection, USP is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, Bicarbonate is administered to patients with End-Stage Renal Disease (ESRD) to treat metabolic acidosis, which may occur in severe renal disease 2.
- The primary goal is to minimize risks inherent to the acidosis itself.
- Treatment should be superimposed on measures designed to control the basic cause of the acidosis.
From the Research
Administration of Bicarbonate in ESRD Patients
Bicarbonate is administered to patients with End-Stage Renal Disease (ESRD) for several reasons:
- To correct metabolic acidosis, a common condition in ESRD patients, which can lead to adverse outcomes such as malnutrition and bone disease 3, 4, 5
- To improve nutritional status and patient outcomes by increasing serum bicarbonate levels 3
- To slow the decline of residual renal function in peritoneal dialysis patients 4
- To preserve residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD) patients 4
Benefits of Bicarbonate Administration
The benefits of bicarbonate administration in ESRD patients include:
- Improved serum bicarbonate levels 3, 4
- Decreased phosphorus levels 3
- Improved nutritional status, as evidenced by decreased protein catabolic rate (nPCR) 3
- Potential reduction in hospitalization rates 5
- Possible beneficial effects on bone metabolism, including reduced bone turnover 5
Current Practice and Future Directions
Current practice trends and implications for bicarbonate therapy in ESRD patients are varied, with some studies suggesting a more individualized approach to bicarbonate therapy in maintenance hemodialysis (MHD) 6