One-Year Conservative Care Using Sodium Bicarbonate Supplementation Is Associated with a Decrease in Electronegative...

Area of Science:

• Nephrology
• Cardiology
• Biochemistry

Background:

• Metabolic acidosis is common in chronic kidney disease (CKD) stages 3-4, potentially accelerating atherosclerosis.
• Low pH in vitro increases low-density lipoprotein (LDL) oxidation, suggesting a link between metabolic acidosis and cardiovascular risk.
• Electronegative LDL (LDL(-)) is a minimally oxidized form of LDL, considered a proatherogenic lipoprotein.

Purpose of the Study:

• To evaluate the effect of oral sodium bicarbonate (NaHCO3) supplementation on LDL(-) plasma levels in CKD patients.
• To assess whether conservative care with alkali therapy can impact atherogenesis markers in CKD.
• To determine the threshold of serum bicarbonate levels associated with beneficial changes in LDL(-).

Main Methods:

• A prospective study involving 31 CKD patients over 15 months.
• Oral sodium bicarbonate (NaHCO3) supplementation initiated at 1.0 mmol/kg/day in the third month.
• Blood samples collected at multiple time points to measure serum bicarbonate and LDL(-) levels.

Main Results:

• Serum bicarbonate levels increased from 20.5 ± 2.9 to 22.6 ± 1.1 mM (p < 0.003) after 12 months of treatment.
• LDL(-) plasma levels significantly decreased from 4.5 ± 3.3 to 2.1 ± 0.9 U/L (p < 0.007).
• These beneficial changes were observed when mean serum bicarbonate levels reached approximately 22 mM.

Conclusions:

• Oral NaHCO3 supplementation stabilized renal function and reduced proatherogenic LDL(-) levels in CKD patients.
• Alkali therapy demonstrated efficacy when serum bicarbonate approached 22 mM.
• This suggests that alkali therapy can be a preventive strategy against atherogenesis in CKD patients, complementing renal disease management.