Comparison of Increased Dose of Oral Sodium Bicarbonate vs Standard Dose in Reduction of Progression of Chronic Kidney Disease

Abstract

Objective: To compare the effect of an increased dose of oral sodium bicarbonate versus the standard dose on the reduction of CKD progression.

Methodology: A Randomized controlled trial was done at Department of Nephrology, PIMS, Islamabad from January 2023 to December 2023. One hundred and eighty patients aged 18-75 years with Chronic Kidney Disease CKD i.e. kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months or more, irrespective of cause were enrolled in this study. Selected Patients were suffering from CKD grade III-V (eGfr15-59). Group A received sodium bicarbonate 300mg X 3 X TDS. Group B received sodium bicarbonate 300mg X 2 X TDS, titrated to maintain 21±1 mmol/L. Both groups received standard CKD treatment and were followed up biweekly for 3 months and monthly thereafter.

Results: Group A had 63.3% males and 36.7% females; Group B had 62.2% males and 37.8% females (P=0.877). Demographic features and baseline comorbidities were similar (P>0.05). Mean serum creatinine was 3.4 mg/dL in Group A and 3.3 mg/dL in Group B (P=0.983). Mean eGFR was 30.6 ml/min in Group A and 30.3 ml/min in Group B (P=0.876). Baseline HCO3 levels were 18.7 mmol/L in Group A and 18.5 mmol/L in Group B (P=0.956). Starting doses were 2700 mg/day in Group A and 1800 mg/day in Group B. eGFR was not significantly different at 3, 6, and 9 months. At 12 months, eGFR was significantly lower in Group B (25.3 ml/min) compared to Group A (26.8 ml/min) (P<0.05). Mean percentage decline in eGFR was significantly different at 9 and 12 months, favouring Group A (P=0.001). The rate of CKD progression was significantly lower in Group A at 12 months (P=0.028).

Conclusions: Higher initial doses of sodium bicarbonate in CKD patients resulted in a significantly lower rate of CKD progression at 12 months compared to the standard dose.