Sodium bicarbonate does not prevent declining kidney function in kidney transplant recipients

1. The mean eGFR slope was comparable among patients allocated to sodium bicarbonate and placebo over 24 months.

2. Sodium bicarbonate was effective in correcting metabolic acidosis, although the effect on renal function remains insignificant.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Metabolic acidosis is a common complication among patients with chronic kidney disease. Although sodium bicarbonate is used to correct this complication, its effect on declining renal function remains unclear. This randomized controlled trial aimed to assess the safety and efficacy of sodium bicarbonate in the prevention of declining estimated glomerular filtration rate (eGFR) among adult kidney transplant patients with metabolic acidosis. The primary outcome was eGFR slope over 24 months while key secondary outcomes included the difference in serum bicarbonate and pH as well as adverse events of interest. According to study results, treatment with sodium bicarbonate did not slow the decline in eGFR compared to placebo in kidney transplant patients, despite treating the underlying metabolic acidosis. Although this study was well-designed, it included failed to identify the dose-dependent effect of sodium bicarbonate among patients with different baseline eGFR.

Click to read the study in The Lancet

Relevant Reading: Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine

In-depth [randomized-controlled trial]: Between Jun 12, 2017, and Jul 10, 2019, 1114 patients were assessed for eligibility across 3 tertiary-care centers in Switzerland. Included were patients with an eGFR between 15 to 89 mL/min/1.73m2, unchanged allograft function and serum bicarbonate ≤ 22 mmol/L. Altogether, 240 patients (121 in placebo and 119 in sodium bicarbonate) were included in the final analysis. The primary endpoint of mean eGFR slope over 24 months was comparable in the sodium bicarbonate (-1.830 mL/min/1.73m2, standard deviation [SD] 6.233) and placebo (-1.862 mL/min/1.73m2, SD 6.344) groups. Although the mean difference in eGFR (0.032 mL/min/1.73m2) was not statistically significant, treatment with sodium bicarbonate (from 21.3 mmol/L to 23.0 mmol/L) corrected metabolic acidosis by adjusting blood pH from (7.37 to 7.39) over 2 years. The majority of adverse events were comparable with 2 fatalities in the placebo group and 1 non-treatment-related fatality in the intervention group. Findings from this study suggest that treatment with sodium bicarbonate does not prevent the progression of kidney disease among adult kidney transplant recipients.

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