Kidney Week

Abstract: PO1493

The Real Life of Oral Alkalinization by Urologists and Nephrologists on Extracellular Volume: The AlcalUN Study

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 2
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolyte, and Acid-Base Disorders

• 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Bertocchio, Jean-philippe, University of Texas MD Anderson Cancer Center, Houston, United States

Jean-philippe Bertocchio,

• Moriniere beaume, Julie, Club des Jeunes Néphrologues, Paris, France

Julie Moriniere beaume,

• Figueres, Lucile, Club des Jeunes Néphrologues, Paris, France

Lucile Figueres,

• Bobot, Mickaël, Club des Jeunes Néphrologues, Paris, France

Mickaël Bobot,

• Aubert, Olivier, Club des Jeunes Néphrologues, Paris, France

Olivier Aubert,

• De laforcade, Louis, Club des Jeunes Néphrologues, Paris, France

Louis De laforcade,

• Ayari, Hamza, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France

Hamza Ayari,

• Dolley-Hitze, Thibault, Club des Jeunes Néphrologues, Paris, France

Thibault Dolley-Hitze,

• Gueutin, Victor, AURA Paris Plaisance, Paris, France

Victor Gueutin,

• Braconnier, Antoine, Club des Jeunes Néphrologues, Paris, France

Antoine Braconnier,

• Golbin, Leonard, Club des Jeunes Néphrologues, Paris, France

Leonard Golbin,

• Citarda, Salvatore, Club des Jeunes Néphrologues, Paris, France

Salvatore Citarda,

• Seret, Guillaume, ECHO Santé, Pôle Santé Sud, Le Mans, France

Guillaume Seret,

• Belaid, Lisa, AUB Santé, Saint-Malo, France, Saint-Malo, France

Lisa Belaid,

• Cohen, Raphael Rc, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France

Raphael Rc Cohen,

• Luque, Yosu, Club des Jeunes Néphrologues, Paris, France

Yosu Luque,

• Seervai, Riyad N. H., Center for Precision Envrionmental Health, Baylor College of Medicine, Houston, Texas, United States

Riyad N. H. Seervai,

• Overs, Camille, Association des Urologues en Formation, Paris, Ile-de-France, France

Camille Overs,

Group or Team Name

• AlcalUN study investigators

Background

Oral alkalinization with sodium bicarbonate (NaHCO₃) or citrate is prescribed to treat conditions ranging from metabolic acidosis to nephrolithiasis. While most nephrologists/urologists use these treatments regularly, extracellular volume (ECV) increase is a main feared adverse event for NaHCO₃ use. To date, no clinical trial has specifically addressed this aspect in clinical routine.

Methods

AlcalUN (NCT03035812) is a multi-center, prospective, open-label study aiming to assess the impact of a chronic oral alkalinization on ECV. Patients receiving oral alkalinization without NaHCO₃ (citrate) comprised the control group. Increased ECV (primary outcome) was assessed based on body weight (BW), blood pressure (BP), and edema at first follow-up visit.

Results

From 02/2017 to 02/2020, 156 patients were enrolled (129 received NaHCO₃, 27 citrate). Out of them, 127 (80%) participants had at least one follow-up visit. Normalizing for demographics, patients in the NaHCO₃ group had higher incidence of chronic kidney disease (68 vs. 30%, p=0.002) and hypertension (75 vs. 35%, p=0.001), while patients in the No-NaHCO₃ group (citrate) had more nephrolithiasis (95 vs. 28%, p<0.001). At baseline, BW, BP, and presence of edema were similar in both groups. After a median of 90 days of treatment, 91 (72%) patients reached the primary outcome, with similar distribution in both groups (71 vs. 75%, p=0.79). We found similar results after after propensity score matching.

Conclusion

Chronic oral alkalinization with NaHCO₃ does not increase ECV more than citrate, even though it is used in a higher-risk population. These results confirm secondary outcomes from other trials, potentially highlighting the role of chloride load instead of sodium load.