Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study

• DOI: 10.1007/s40620-019-00656-5
• Publication Date: 2019-10-30T11:43:17Z
• Authors: Biagio R. Di Iorio; Antonio Bellasi; Kalani L. Raphael; Domenico Santoro; Filippo Aucella; Luciano Garofano; Michele Ceccarelli; Luca Di Lullo; Giovanna Capolongo; Mattia Di Iorio; Pasquale Guastaferro; Giovambattista Ca...
• Keywords: Male; Metabolic acidosis; Sodium bicarbonate; Kidney; 16. Peace & justice; 3. Good health; Chronic kidney disease; Metabolic acidosis; Sodium bicarbonate; Acidosis; Aged; Disease Progression; Female; Glomerular Filtration Rate; Humans; Italy; Kidney; Male; Renal Insufficiency, Chronic; Sodium Bicarbonate; Survival Rate; Survival Rate; 03 medical and health sciences; Sodium Bicarbonate; 0302 clinical medicine; Italy; Chronic kidney disease; Disease Progression; Humans; Original Article; Female; Chronic kidney disease; Metabolic acidosis; Sodium bicarbonate; Renal Insufficiency, Chronic; Acidosis; Aged; Glomerular Filtration Rate

Abstract

Background Metabolic acidosis is associated with accelerated progression of chronic kidney disease (CKD). Whether treatment of metabolic acidosis with sodium bicarbonate improves kidney and patient survival in CKD is unclear.

Methods We conducted a randomized (ratio 1:1). open-label, controlled trial (NCT number: NCT01640119. www.clinicaltrials.gov) to determine the effect in patients with CKD stage 3–5 of treatment of metabolic acidosis with sodium bicarbonate (SB) on creatinine doubling (primary endpoint), all-cause mortality and time to renal replacement therapy compared to standard care (SC) over 36-months. Parametric, non-parametric tests and survival analyses were used to assess the effect of SB on these outcomes.

Results A total of 376 and 364 individuals with mean (SD) age 67.8 (14.9) years, creatinine clearance 30 (12) ml/min, and serum bicarbonate 21.5 (2.4) mmol/l were enrolled in SB and SC, respectively. Mean (SD) follow-up was 29.6 (9.8) vs 30.3 (10.7) months in SC and SB. respectively. The mean (SD) daily doses of SB was 1.13 (0.10). 1.12 (0.11). and 1.09 (0.12) mmol/kg*bw/day in the first, second and third year of follow-up, respectively. A total of 87 participants reached the primary endpoint [62 (17.0%) in SC vs 25 (6.6%) in SB, p < 0.001). Similarly, 71 participants [45 (12.3%) in SC and 26 (6.9%) in SB, p = 0.016] started dialysis while 37 participants [25 (6.8%) in SC and 12 (3.1%) in SB, p = 0.004] died. There were no significant effect of SB on blood pressure, total body weight or hospitalizations.

Conclusion In persons with CKD 3–5 without advanced stages of chronic heart failure, treatment of metabolic acidosis with sodium bicarbonate is safe and improves kidney and patient survival.