Clin J Am Soc Nephrol. 2023 Feb 9. doi: 10.2215/CJN.0000000000000119. Online ahead of print.
BACKGROUND: Individuals with chronic kidney disease (CKD) are at an increased risk for cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic blood pressure. Sodium bicarbonate is an efficacious treatment for acidosis, although this may also increase systolic blood pressure. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic blood pressure and antihypertensive medication change (which may indicate systolic blood pressure change) in response to sodium bicarbonate therapy in CKD patients.
METHODS: MEDLINE, EMBASE, CINHAL, AMED, COCHRANE, and WHO trials registry databases were searched for randomized control trials (RCTs) where sodium bicarbonate was compared to placebo/usual care in CKD stage G1-5 non-dialysis dependent populations. Random effects meta-analyses were used to evaluate changes in systolic blood pressure and blood pressure-modifying drugs following sodium bicarbonate intervention.
RESULTS: Fourteen RCTs (2,110 participants, median follow-up 27 (IQR 97) weeks, mean age 60 (SD 10) years, mean systolic blood pressure 136 (SD 17) mmHg, mean eGFR 38 (SD 10) ml/min, mean serum bicarbonate 22 (SD 4) mmol/l), were eligible for inclusion. Meta-analysis suggests that sodium bicarbonate does not influence systolic blood pressure in individuals with CKD stage G1-5. Results were consistent when stratifying by dose of sodium bicarbonate or duration of intervention. Similarly, there was no significant increase in the use of antihypertensive medication or diuretics in individuals taking sodium bicarbonate whereas, there was a greater decrease in antihypertensive medication use in individuals taking sodium bicarbonate compared to controls.
CONCLUSIONS: Our results suggest, with moderate certainty, that sodium bicarbonate supplementation does not adversely affect systolic blood pressure in CKD or negatively influence antihypertensive medication requirements.
PMID:36758154 | DOI:10.2215/CJN.0000000000000119