Effect of Treatment of Metabolic Acidosis on Vascular Endothelial Function in Patients with CKD: A Pilot Randomized Cross-Over Study.

Abstract

BACKGROUND AND OBJECTIVES:

We examined the effect of alkali replacement for metabolic acidosis on vascular endothelial function in patients with CKD.

METHODS:

We performed a pilot, prospective, open-label 14-week crossover study examining the effect of oral sodium bicarbonate treatment on vascular function in 20 patients with an eGFR of 15-44 ml/min per 1.73 m2 with low serum bicarbonate levels (16-21 mEq/L). Each period was 6 weeks in duration with a 2-week washout period in between. Patients were treated to goal serum bicarbonate of ≥23 mEq/L. The primary end point was change in brachial artery flow-mediated dilation (FMD) between treatment and control conditions. Secondary end points included changes in markers of inflammation, bone turnover, mineral metabolism, and calcification.

RESULTS:

Eighteen patients completed the study and were included in the primary efficacy analysis. The mean (SD) age and eGFR were 59 (12) years and 26 (8) ml/min per 1.73 m2, respectively. Serum bicarbonate increased significantly with sodium bicarbonate treatment (+2.7±2.9 mEq/L, P≤0.001), whereas there was no change in bicarbonate levels in the control group. FMD significantly improved after sodium bicarbonate therapy (mean±SD, FMD baseline: 4.1%±4.1%; 6 weeks: 5.2%±2.9%; P=0.04) There was no significant change in FMD in the control group (mean±SD, FMD baseline: 4.6%±3.1%; 6 weeks: 4.1%±3.4%; P=0.20). Compared with control, sodium bicarbonate treatment resulted in a significant increase in FMD (mean, 1.8%; 95% confidence interval, 0.3 to 3.3; P=0.02). There was no significant change in bone markers or serum calcification propensity with treatment. Serum phosphorus and intact fibroblast growth factor 23 increased significantly during treatment.

CONCLUSIONS:

Treatment of metabolic acidosis with sodium bicarbonate significantly improved vascular endothelial function in patients with stages 3b and 4 CKD.

• Authors: Jessica Kendrick, Pratik Shah, Emily Andrews, Zhiying You, Kristen Nowak, Andreas Pasch, Michel Chonchol
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 13 Issue 10 Pg. 1463-1470 (10 08 2018) ISSN: 1555-905X [Electronic] United States
• PMID: 30237219 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2018 by the American Society of Nephrology.

Chemical References

• Sodium Bicarbonate

Topics

• Acidosis (drug therapy, etiology)
• Cross-Over Studies
• Endothelium, Vascular (drug effects)
• Female
• Humans
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Renal Insufficiency, Chronic (complications)
• Sodium Bicarbonate (pharmacology, therapeutic use)