From the Guidelines
Bicarbonate supplements are recommended for individuals with chronic kidney disease (CKD) and serum bicarbonate concentrations < 22 mmol/l to maintain serum bicarbonate within the normal range, unless contraindicated. This recommendation is based on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD, as suggested in the American Journal of Kidney Diseases 1 and further supported by Kidney International 1. The suggested treatment involves oral bicarbonate supplementation, with the goal of maintaining serum bicarbonate levels within the normal range.
- Key considerations for bicarbonate supplementation include:
- Starting with lower doses to minimize side effects such as bloating, gas, and stomach discomfort
- Taking the supplement with food to reduce gastrointestinal side effects
- Regular monitoring by a healthcare provider to ensure appropriate dosing and avoid complications, especially for those with heart conditions, high blood pressure, or sodium restrictions
- The primary mechanism of action of bicarbonate supplements is to neutralize excess acid in the body, helping maintain proper pH balance, which is crucial for individuals with metabolic acidosis, kidney disease, or acid reflux.
- It is essential to consult a healthcare provider before using bicarbonate supplements, especially for individuals with certain medical conditions or those who require pH management, to determine the appropriate dosage and minimize potential risks.
From the FDA Drug Label
Sodium Bicarbonate Injection, USP is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis Treatment of metabolic acidosis should, if possible, be superimposed on measures designed to control the basic cause of the acidosis Vigorous bicarbonate therapy is required in any form of metabolic acidosis where a rapid increase in plasma total CO2 content is crucial - e. g., cardiac arrest, circulatory insufficiency due to shock or severe dehydration, and in severe primary lactic acidosis or severe diabetic acidosis.
Bicarbonate supplement is indicated for the treatment of metabolic acidosis in various conditions, including severe renal disease, uncontrolled diabetes, and circulatory insufficiency due to shock or severe dehydration. The primary goal of bicarbonate therapy is to minimize the risks associated with acidosis itself, while also addressing the underlying cause of the condition. Key indications for bicarbonate supplement include:
- Metabolic acidosis
- Severe renal disease
- Uncontrolled diabetes
- Circulatory insufficiency due to shock or severe dehydration
- Cardiac arrest
- Severe primary lactic acidosis or severe diabetic acidosis 2
From the Research
Bicarbonate Supplement Effects
- The effect of bicarbonate supplementation on renal function has been studied in various clinical trials 3, 4, 5, 6.
- A study published in 2013 found that oral sodium bicarbonate supplementation may halt the progression of decline of renal function in patients with chronic kidney disease (CKD) stage 3 or 4 3.
- However, a 2021 study found that sodium bicarbonate supplementation did not significantly change the urinary excretion of renin, angiotensinogen, aldosterone, endothelin-1, albumin, or α1-microglobulin in patients with CKD stage G4 and plasma bicarbonate 15-24 mmol/l 4.
- A 2020 study found that oral sodium bicarbonate did not improve physical function, quality of life, markers of renal function, bone turnover, and vascular health in older people with CKD and mild acidosis 5.
- A 2014 study found that bicarbonate supplementation slowed the rate of decline of renal function in stage 4 CKD and improved nutritional indices in stage 5 CKD 6.
Bicarbonate Supplement Usage
- The use of sodium bicarbonate to treat metabolic acidosis is intuitive, yet data suggest that not all patients benefit from this therapy 7.
- Sodium bicarbonate can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion 7.
- Empiric use of sodium bicarbonate in patients with nontoxicologic causes of metabolic acidosis is not warranted and likely does not improve patient-centered outcomes, except in select scenarios 7.
- Patients with a nongap acidosis may benefit from sodium bicarbonate supplementation 7.
Bicarbonate Supplement Side Effects
- Adverse events were more frequent in the bicarbonate arm compared to the placebo arm in a 2020 study 5.
- Time to commencement of renal replacement therapy was similar in both groups in a 2020 study 5.
- Health economic analysis showed higher costs and lower quality of life in the bicarbonate arm at 1 year in a 2020 study 5.