Kidney Week

Abstract: FR-PO246

Effects of Alkali Therapy on Renal Outcomes: A Systematic Review and Meta-Analysis

Session Information

• CKD: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Hultin, Sebastian Olof, Australasian Kidney Trials Network, Sydney, New South Wales, Australia

Sebastian Olof Hultin,

• Hood, Christopher J., Australasian Kidney Trials Network, Sydney, New South Wales, Australia

Christopher J. Hood,

• Toussaint, Nigel David, Australasian Kidney Trials Network, Sydney, New South Wales, Australia

Nigel David Toussaint,

• Johnson, David W., Australasian Kidney Trials Network, Sydney, New South Wales, Australia

David W. Johnson,

• Badve, Sunil V., Australasian Kidney Trials Network, Sydney, New South Wales, Australia

Sunil V. Badve,

Background

Preclinical studies suggest that treatment of metabolic acidosis may slow the progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of alkali therapy on renal outcomes.

Methods

Medline, Embase and Cochrane Central Register of Controlled Trials were searched for RCTs with at least 3 months of follow-up in patients with CKD defined as eGFR <60mL/min/1.73m2 or the presence of albuminuria that reported renal outcomes. Treatment effects were summarized using random-effects meta-analysis.

Results

Eight trials involving 679 participants (median sample size 80, median follow-up 12 months) evaluating sodium bicarbonate treatment were eligible for inclusion. Of these, 3 trials were a placebo-controlled studies. Overall, risk of bias was unclear or high risk. Compared to no study medication or placebo, treatment with sodium bicarbonate resulted in slower decline in kidney function (7 trials, standardized mean difference [SMD] for change from baseline in glomerular filtration rate or creatinine clearance 0.29 [95%CI 0.11, 0.48]. Sodium bicarbonate abrogated increases in serum creatinine from baseline (4 trials, weighted mean difference [WMD] -0.07 [95%CI -0.12, -0.03] mg/dL) and reduced the risk of end-stage kidney disease (4 trials, risk ratio [RR] 0.44 [95%CI 0.22, 0.88]). Sodium bicarbonate had uncertain effects on proteinuria (3 trials, SMD -0.27 [95%CI -0.59, 0.05]) and systolic blood pressure (6 trials, WMD 0.27 [95%CI -3.01, 3.56] mm Hg). Data for effects of sodium bicarbonate on death and adverse events were scant.

Conclusion

Alkali therapy with sodium bicarbonate may slow the progression of CKD. Adequately powered RCTs are required to evaluate the benefits and risks of alkali therapy in CKD.