TY - JOUR
T1 - A Systematic Review and Meta-Analysis on Effects of Bicarbonate Therapy on Kidney Outcomes
AU - Hultin, Sebastian
AU - Hood, Chris
AU - Campbell, Katrina L.
AU - Toussaint, Nigel D.
AU - Johnson, David W.
AU - Badve, Sunil V.
N1 - Funding Information:
The authors gratefully thank Dr Sinee Disthabanchong (Ramathibodi Hospital, Mahidol University, Bangkok, Thailand), Dr Donald E. Wesson (Texas A&M College of Medicine, Scott and White Healthcare, Temple, Texas, USA), Professor Muhammad Yaqoob (William Harvey Research Institute and Barts and the London NHS Trust, London, United Kingdom), A/Professor Kalani Raphael (University of Utah, Salt Lake City, USA), and Professor Miles Witham (NIHR Newcastle Biomedical Research Centre, Newcastle University, United Kingdom) for providing requested data. DWJ is supported by an Australian Government National Health and Medical Research Council (NHMRC) Practitioner Fellowship. SVB is supported by a John Chalmers Clinical Research Fellowship with the support of Servier from The George Institute for Global Health, Australia. These supporting organizations/agencies had no role in the design and conduct of the study, analysis and interpretation of the data, review and approval of the manuscript, and decision to submit the manuscript. Study design: SH, CH, NDT, KLC, DWJ, SVB; Literature search, study selection, and data extraction: SH, SVB; Statistical analysis and interpretation: SH, NDT, CH, KLC, SVB; Supervision: DWJ, SVB. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.
Publisher Copyright:
© 2021 International Society of Nephrology
PY - 2021/3
Y1 - 2021/3
N2 - Aim: Preclinical studies suggest treatment of metabolic acidosis may slow chronic kidney disease (CKD) progression. This systematic review aimed to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of bicarbonate therapy on kidney outcomes. Methods: Medline, EMBASE, and Cochrane databases were searched for RCTs with ≥3 months’ follow-up in patients with CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min per 1.73 m2 and/or proteinuria) comparing the effects of sodium bicarbonate with placebo/no study medication on kidney outcomes. The primary outcome was change from baseline to last measurement in kidney function measured as either eGFR or creatinine clearance. Treatment effects were summarized using random-effects meta-analysis. Results: Fifteen trials (2445 participants, median follow-up 12 months) were eligible for inclusion. Compared with placebo or no study medication, sodium bicarbonate retarded the decline in kidney function (standardized mean difference [SMD]: 0.26; 95% confidence interval [CI]: 0.13–0.40; I2 = 50%, low certainty evidence), and reduced the risk of end-stage kidney failure (risk ratio [RR]: 0.53; 95% CI 0.32–0.89; I2 = 69%, low certainty evidence). The effect of sodium bicarbonate on proteinuria (SMD: −0.09; 95% CI −0.27 to 0.09; I2 = 28%, very low certainty evidence), systolic blood pressure (weighted mean difference [WMD]: −0.57 mm Hg; 95% CI −2.32 to 1.18; I2 = 0%, low certainty evidence), all-cause death (RR: 0.81; 95% CI: 0.39–1.68; I2 = 30%; very low certainty evidence) and edema (RR: 1.16; 95% CI: 0.90–1.50; I2 = 28%; low certainty evidence) were uncertain.Conclusion: Sodium bicarbonate may slow CKD progression. Adequately powered randomized trials are required to evaluate the benefits and risks of sodium bicarbonate in CKD.
AB - Aim: Preclinical studies suggest treatment of metabolic acidosis may slow chronic kidney disease (CKD) progression. This systematic review aimed to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of bicarbonate therapy on kidney outcomes. Methods: Medline, EMBASE, and Cochrane databases were searched for RCTs with ≥3 months’ follow-up in patients with CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min per 1.73 m2 and/or proteinuria) comparing the effects of sodium bicarbonate with placebo/no study medication on kidney outcomes. The primary outcome was change from baseline to last measurement in kidney function measured as either eGFR or creatinine clearance. Treatment effects were summarized using random-effects meta-analysis. Results: Fifteen trials (2445 participants, median follow-up 12 months) were eligible for inclusion. Compared with placebo or no study medication, sodium bicarbonate retarded the decline in kidney function (standardized mean difference [SMD]: 0.26; 95% confidence interval [CI]: 0.13–0.40; I2 = 50%, low certainty evidence), and reduced the risk of end-stage kidney failure (risk ratio [RR]: 0.53; 95% CI 0.32–0.89; I2 = 69%, low certainty evidence). The effect of sodium bicarbonate on proteinuria (SMD: −0.09; 95% CI −0.27 to 0.09; I2 = 28%, very low certainty evidence), systolic blood pressure (weighted mean difference [WMD]: −0.57 mm Hg; 95% CI −2.32 to 1.18; I2 = 0%, low certainty evidence), all-cause death (RR: 0.81; 95% CI: 0.39–1.68; I2 = 30%; very low certainty evidence) and edema (RR: 1.16; 95% CI: 0.90–1.50; I2 = 28%; low certainty evidence) were uncertain.Conclusion: Sodium bicarbonate may slow CKD progression. Adequately powered randomized trials are required to evaluate the benefits and risks of sodium bicarbonate in CKD.
UR - http://www.scopus.com/inward/record.url?scp=85100396205&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2020.12.019
DO - 10.1016/j.ekir.2020.12.019
M3 - Review article
AN - SCOPUS:85100396205
SN - 2468-0249
VL - 6
SP - 695
EP - 705
JO - Kidney International Reports
JF - Kidney International Reports
IS - 3
ER -