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. 2007 Jan 24;2007(1):CD001890.
doi: 10.1002/14651858.CD001890.pub3.

Correction of chronic metabolic acidosis for chronic kidney disease patients

P Roderick  1 , N S Willis, S Blakeley, C Jones, C Tomson
Affiliations

Correction of chronic metabolic acidosis for chronic kidney disease patients

P Roderick et al. Cochrane Database Syst Rev. .

Abstract

Background: Metabolic acidosis is a feature of chronic kidney disease (CKD) due to the reduced capacity of the kidney to synthesise ammonia and excrete hydrogen ions. It has adverse consequences on protein and muscle metabolism, bone turnover and the development of renal osteodystrophy. Metabolic acidosis may be corrected by oral bicarbonate supplementation or in dialysis patients by increasing the bicarbonate concentration in dialysate fluid.

Objectives: To examine the benefits and harms of treating metabolic acidosis in patients with CKD, both prior to reaching end-stage renal disease (ESRD) or whilst on renal replacement therapy (RRT), with sodium bicarbonate or increasing the bicarbonate concentration of dialysate.

Search strategy: We searched CENTRAL (The Cochrane Library, issue 4 2005), Cochrane Renal Group's specialised register (October 2005), MEDLINE (1966 - October 2005) and EMBASE (1980 - October 2005).

Selection criteria: Randomised controlled trials (RCTs), crossover RCTs and quasi-RCTs investigating the correction of chronic metabolic acidosis in adults or children with CKD.

Data collection and analysis: Outcomes were analysed using relative risk (RR) and weighted mean difference (MD) for continuous measures.

Main results: We identified three trials in adult dialysis patients (n = 117). There were insufficient data for most outcomes for meta-analysis. In all three trials acidosis improved in the intervention group though there was variation in achieved bicarbonate level. There was no evidence of effect on blood pressure or sodium levels. Some measures of nutritional status/protein metabolism (e.g. SGA, NP NA) were significantly improved by correction in the one trial that looked in these in detail. There was heterogeneity of the effect on serum albumin in two trials. Serum PTH fell significantly in the two trials that estimated this, there was no significant effect on calcium or phosphate though both fell after correction. Complex bone markers were assessed in one study, with some evidence for a reduction in bone turnover in those with initial high bone turnover and an increase in low turnover patients. The studies were underpowered to assess clinical outcomes, in the one study that did there was some evidence for a reduction in hospitalisation after correction.

Authors' conclusions: The evidence for the benefits and risks of correcting metabolic acidosis is very limited with no RCTs in pre-ESRD patients, none in children, and only three small trials in dialysis patients. These trials suggest there may be some beneficial effects on both protein and bone metabolism but the trials were underpowered to provide robust evidence.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 1 Treatment‐related outcomes: Bicarbonate.
1.2
1.2. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 2 Treatment‐related outcpmes: Sodium.
1.3
1.3. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 3 Treatment‐related outcomes: Blood pressure.
1.4
1.4. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 4 Treatment‐related outcomes: Kt/V.
1.5
1.5. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 5 Nutritional outcomes.
1.6
1.6. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 6 Bone metabolism outcomes: Phosphorus, osteocalcin and calcium.
1.7
1.7. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 7 Bone metabolism outcomes: PTH.
1.8
1.8. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 8 Bone metabolism outcomes: Volume, surfaces, number and formation.
1.9
1.9. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 9 Clinical outcomes: All‐cause mortality, hosptalisation.
1.10
1.10. Analysis
Comparison 1 Oral or dialysis bicarbonate vs placebo, control or usual dialysis bicarbonate, Outcome 10 Clinical outcomes: Hospital admissions/patient, length of hospital stay.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD001890.pub2

References

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