Safety and efficacy of sodium bicarbonate for treating metabolic acidosis in chronic kidney disease: A systematic review and meta-analysis.

Abstract

Background: Kidney dysfunction and reduced filtration capacity due to chronic kidney disease (CKD) lead to a shift in the body's acid-base balance, ultimately causing metabolic acidosis (MA). Sodium bicarbonate has been used as a supplement to alleviate the symptoms and reverse the acidosis, and it may even slow the progression of CKD. However, its safety profile and overall effectiveness are uncertain.

Aim: To conduct a systematic review and meta-analysis of clinical trials assessing sodium bicarbonate's safety and efficacy for treating CKD-induced MA.

Methods: Medline, Scopus, EMBASE, and Cochrane Central were systematically searched from inception until May 2024 to select all relevant randomized control trials (RCTs) and non-RCT (NRCTs) evaluating the effectiveness of sodium bicarbonate in correcting MA in end-stage renal disease patients. In addition, ClinicalTrials.gov, Medrxiv.org, and Google Scholar were searched for other literature. A random-effects meta-analysis was performed to derive mean differences (MD) and risk ratios (RR) with their 95%CI for continuous and dichotomous outcomes respectively.

Results: Following a systematic search of the databases, 20 RCTs and 2 and NRCTs comprising 2932 patients were included in our study. The results revealed that sodium bicarbonate significantly increased serum bicarbonate in CKD patients (MD: 2.59, 95%CI: 0.95-4.22; P = 0.02; I ² = 95%). However, there was a non-significant increase in estimated glomerular filtration rate (eGFR) in patients on sodium bicarbonate therapy (MD: 0.93, 95%CI: -1.88-3.75; P = 0.52; I ² = 93%). Upon assessment of the safety profile of sodium bicarbonate, no significant association was found in the outcomes of death/prolonged hospitalization (RR: 1.05, 95%CI: 0.84-1.32; P = 0.66; I ² = 0%), or gastrointestinal disorders (RR: 1.64, 95%CI: 0.35-7.66; P = 0.53; I ² = 76%), or worsening edema (RR: 1.26, 95%CI: 0.94-1.68; P = 0.12; I ² = 37%) when compared to control.

Conclusion: Sodium bicarbonate therapy may halt worsening kidney function by correcting serum bicarbonate levels and treating MA. Although sodium bicarbonate does not significantly improve the eGFR, it may potentially prevent CKD progression while maintaining an overall favorable safety profile.