Bicarbonate Supplementation Slows Progression of CKD and... : Journal of the American Society of Nephrology (original) (raw)
CLINICAL RESEARCH
Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status
de Brito-Ashurst, Ione; Varagunam, Mira; Raftery, Martin J.; Yaqoob, Muhammad M.
Department of Renal Medicine and Transplantation, William Harvey Research Institute and Barts and the London NHS Trust, London, United Kingdom
Correspondence: Prof. Muhammad M. Yaqoob, Department of Renal Medicine and Transplantation, Royal London Hospital, Whitechapel, London E1 1BB UK. Phone: +442073777236; Fax: +442073777003; E-mail: [email protected]
Received November 24, 2008
Accepted May 18, 2009
Abstract
Bicarbonate supplementation preserves renal function in experimental chronic kidney disease (CKD), but whether the same benefit occurs in humans is unknown. Here, we randomly assigned 134 adult patients with CKD (creatinine clearance [CrCl] 15 to 30 ml/min per 1.73 m2) and serum bicarbonate 16 to 20 mmol/L to either supplementation with oral sodium bicarbonate or standard care for 2 yr. The primary end points were rate of CrCl decline, the proportion of patients with rapid decline of CrCl (>3 ml/min per 1.73 m2/yr), and ESRD (CrCl <10 ml/min). Secondary end points were dietary protein intake, normalized protein nitrogen appearance, serum albumin, and mid-arm muscle circumference. Compared with the control group, decline in CrCl was slower with bicarbonate supplementation (5.93 versus 1.88 ml/min 1.73 m2; P < 0.0001). Patients supplemented with bicarbonate were significantly less likely to experience rapid progression (9 versus 45%; relative risk 0.15; 95% confidence interval 0.06 to 0.40; P < 0.0001). Similarly, fewer patients supplemented with bicarbonate developed ESRD (6.5 versus 33%; relative risk 0.13; 95% confidence interval 0.04 to 0.40; P < 0.001). Nutritional parameters improved significantly with bicarbonate supplementation, which was well tolerated. This study demonstrates that bicarbonate supplementation slows the rate of progression of renal failure to ESRD and improves nutritional status among patients with CKD.
Copyright © 2009 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
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