A Systematic Review and Meta-Analysis on Effects of Bicarbonate Therapy on Kidney Outcomes

Preclinical studies suggest treatment of metabolic acidosis may slow chronic kidney disease (CKD) progression. This systematic review aimed to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of bicarbonate therapy on kidney outcomes.

Medline, EMBASE, and Cochrane databases were searched for RCTs with ≥3 months' follow-up in patients with CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min per 1.73 m² and/or proteinuria) comparing the effects of sodium bicarbonate with placebo/no study medication on kidney outcomes. The primary outcome was change from baseline to last measurement in kidney function measured as either eGFR or creatinine clearance. Treatment effects were summarized using random-effects meta-analysis.

Fifteen trials (2445 participants, median follow-up 12 months) were eligible for inclusion. Compared with placebo or no study medication, sodium bicarbonate retarded the decline in kidney function (standardized mean difference [SMD]: 0.26; 95% confidence interval [CI]: 0.13-0.40; I ² = 50%, low certainty evidence), and reduced the risk of end-stage kidney failure (risk ratio [RR]: 0.53; 95% CI 0.32-0.89; I ² = 69%, low certainty evidence). The effect of sodium bicarbonate on proteinuria (SMD: -0.09; 95% CI -0.27 to 0.09; I ² = 28%, very low certainty evidence), systolic blood pressure (weighted mean difference [WMD]: -0.57 mm Hg; 95% CI -2.32 to 1.18; I ² = 0%, low certainty evidence), all-cause death (RR: 0.81; 95% CI: 0.39-1.68; I ² = 30%; very low certainty evidence) and edema (RR: 1.16; 95% CI: 0.90-1.50; I ² = 28%; low certainty evidence) were uncertain.

Sodium bicarbonate may slow CKD progression. Adequately powered randomized trials are required to evaluate the benefits and risks of sodium bicarbonate in CKD.