Kidney Week

Abstract: TH-PO1104

Effect of Sodium Bicarbonate Treatment on Blood B-Type Natriuretic Peptide Levels: Secondary Analysis of the Alkali Therapy in CKD, VA-Bicarb, and BASE Trials

Session Information

• CKD: Therapies, Innovations, and Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Archey, Ava E, New York University, New York, New York, United States

Ava E Archey

• Koike, Seiji, Oregon Health & Science University, Portland, Oregon, United States

Seiji Koike, MS

• Hostetter, Thomas H., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Thomas H. Hostetter, MD

• Dobre, Mirela A., University Hospitals Health System, Cleveland, Ohio, United States

Mirela A. Dobre, MD, MPH, FASN

• Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States

Alfred K. Cheung, MD

• Chen, Wei, Albert Einstein College of Medicine, New York, New York, United States

Wei Chen, MD, MS, FASN

• Abramowitz, Matthew K., Albert Einstein College of Medicine, New York, New York, United States

Matthew K. Abramowitz, MD, MS, FASN

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix, MD, FASN

• Raj, Dominic S., George Washington University Medical Faculty Associates, Washington, District of Columbia, United States

Dominic S. Raj, MD, FASN

• Wolf, Myles, Weill Cornell Medicine, New York, New York, United States

Myles Wolf, MD, MS, MSc

• Fried, Linda F., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Linda F. Fried, MD, MPH, FASN

• Gassman, Jennifer J., Cleveland Clinic, Cleveland, Ohio, United States

Jennifer J. Gassman, MS, PhD

• Kendrick, Cynthia A., Cleveland Clinic, Cleveland, Ohio, United States

Cynthia A. Kendrick

• Larive, Brett, Cleveland Clinic, Cleveland, Ohio, United States

Brett Larive

• Block, Geoffrey A., US Renal Care Inc, Decatur, Georgia, United States

Geoffrey A. Block, MD, FASN

• Li, Ping, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States

Ping Li, MD, MPH, FASN

• Middleton, John Paul, Duke University, Durham, North Carolina, United States

John Paul Middleton, MD

• Sprague, Stuart Michael, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States

Stuart Michael Sprague, DO

• Wesson, Donald E., The University of Texas at Austin Dell Medical School, Austin, Texas, United States

Donald E. Wesson, MD, MBA, FASN

• Price, Tara R, University of Utah Health, Salt Lake City, Utah, United States

Tara R Price, PhD

• Lapidus, Jodi A., Oregon Health & Science University, Portland, Oregon, United States

Jodi A. Lapidus, PhD

• Gudino, Paola, Albert Einstein College of Medicine, New York, New York, United States

Paola Gudino, MD

• Raphael, Kalani L., University of Utah Health, Salt Lake City, Utah, United States

Kalani L. Raphael, MD, MS, FASN

• Melamed, Michal L., New York University, New York, New York, United States

Michal L. Melamed, MD

Background

Chronic oral sodium bicarbonate (NaHCO₃) is often used to treat metabolic acidosis in chronic kidney disease (CKD) but may cause volume retention. We conducted a secondary analysis of three clinical trials to determine the effect of oral NaHCO₃ on serum B-type natriuretic peptide (BNP) levels, a proxy for volume retention.

Methods

BNP was measured in stored serum samples collected at baseline, month-3, and month-6 from three randomized, double-blinded, placebo-controlled trials. Alkali Therapy in CKD (ATCKD), consisting of 149 enrollees with baseline eGFRs 15-59mL/min/1.73m², and VA-Bicarb, consisting of 74 diabetic veterans with eGFRs 15-89mL/min/1.73m², randomized participants 1:1 to daily low-dose NaHCO₃ (0.4 and 0.5 mEq/kg, respectively) or placebo. BASE randomized 194 participants with eGFRs 20-59mL/min/1.73m² to daily high-dose NaHCO₃ (0.8mEq/kg; n=90), low dose NaHCO₃ (0.5mEq/kg; n=52), or placebo (n=52). Linear mixed-effects models assessed dose group differences in log-transformed BNP levels. Pairwise comparisons of the NaHCO₃ effect on BNP at each visit were performed: high-dose, low-dose or any-dose versus applicable placebo cohort.

Results

At baseline, ATCKD participants had a mean eGFR of 36±11mL/min/1.73m² and median (interquartile range IQR) BNP of 129.8 (44.6-423.4) pg/mL; VA-Bicarb had a mean eGFR of 56±20mL/min/1.73m² and median BNP of 80.7 (48.4-218.7) pg/mL; and BASE had a mean eGFR of 36±9mL/min/1.73m² and BNP of 115.1 (63.0-261.1) pg/mL. Baseline differences between groups were not significant. Relative to placebo, randomization to any dose of NaHCO₃ had no significant effect on log-BNP values at months 3 (p=0.34; 95% CI, -0.14-0.41) and 6 (p=0.23; 95% CI, -0.11-0.45) and insufficiently explained the variance in log-BNP levels (R²=0.39%). Low- and high-dose NaHCO₃ did not significantly affect log-BNP relative to placebo at any visit.

Conclusion

Daily oral sodium bicarbonate therapy did not significantly affect serum BNP levels, suggesting no extracellular volume expansion induced by NaHCO₃, in patients with CKD stages 2-4.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025kedj54mk