Electrolyte Blood Press.  2014 Dec;12(2):80-87. 10.5049/EBP.2014.12.2.80.

Effect of Bicarbonate Supplementation on Renal Function and Nutritional Indices in Predialysis Advanced Chronic Kidney Disease

• Jeong J
• Kwon SK
• Kim HY

• KMID: 2052335
• DOI: http://doi.org/10.5049/EBP.2014.12.2.80

Abstract

Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR <15mL/min per 1.73m2) and 40 patients with stage 4 CKD (eGFR 15 to 30mL/min per 1.73m2) who had a total CO2 less than 22mEq/L were assigned into the bicarbonate treatment group or control group for 12 months. In stage 4 CKD, there were significant differences in the changes of eGFR during the study between the treatment group and the control group (-2.30+/-4.49 versus -6.58+/-6.32mL/min/1.73m2, p<0.05). However, in stage 5 CKD, there were no significant differences in the change of eGFR during the study between the two groups (-2.10+/-2.06 versus -3.23+/-1.95mL/min/1.73 m2).There were no significant differences in the changes of nutritional indices such as albumin, prealbumin, transferrin, total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.

Keyword

Chronic kidney disease; Acidosis; Bicarbonate; Nutrition assessment

MeSH Terms

Acidosis
Alkalies
Glomerular Filtration Rate
Humans
Lymphocyte Count
Malnutrition
Nutrition Assessment*
Prealbumin
Renal Insufficiency, Chronic*
Sodium Bicarbonate
Transferrin
Alkalies
Prealbumin
Sodium Bicarbonate
Transferrin

Figure

• 

  Fig. 1 Changes of Total CO2 during the Study Period. (A) The change of total CO2 in stage 5 CKD. (B) The change of total CO2 in stage 4 CKD. There was significant difference in changes of total CO2 level in the treatment group (solid line) compared with the control group (dotted line) during study period. T: Treatment group with oral sodium bicarbonate, C: Control group, *:p<0.05 vs Control group.

• 

  Fig. 2 Changes of Renal Function during the Study Period. (A) The decline of eGFR was similar between the treatment group and control group in stage 5 CKD. (B)The decline of eGFR was significantly lower in the treatment group (solid line) compared with control group (dotted line) in stage 4 CKD. T: Treatment group with oral sodium bicarbonate, C: Control group, *:p<0.05 vs Control group.

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