Format

Send to

Choose Destination
Clin J Am Soc Nephrol. 2019 Jul 5;14(7):1011-1020. doi: 10.2215/CJN.13091118. Epub 2019 Jun 13.

Effects of Treatment of Metabolic Acidosis in CKD: A Systematic Review and Meta-Analysis.

Author information

1
Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Sankar.navaneethan@bcm.edu.
2
Tricida, Inc., South San Francisco, CA; and.
3
Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Abstract

BACKGROUND AND OBJECTIVES:

Metabolic acidosis is associated with progression of CKD and has significant adverse effects on muscle and bone. A systematic review and meta-analysis was conducted to evaluate the benefits and risks of metabolic acidosis treatment with oral alkali supplementation or a reduction of dietary acid intake in those with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

MEDLINE, Embase, and Cochrane CENTRAL were searched for relevant trials in patients with stage 3-5 CKD and metabolic acidosis (<22 mEq/L) or low-normal serum bicarbonate (22-24 mEq/L). Data were pooled in a meta-analysis with results expressed as weighted mean difference for continuous outcomes and relative risk for categorical outcomes with 95% confidence intervals (95% CIs), using a random effects model. Study quality and strength of evidence were assessed using Cochrane risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS:

Fourteen clinical trials were included (n=1394 participants). Treatment of metabolic acidosis with oral alkali supplementation or a reduction of dietary acid intake increased serum bicarbonate levels (14 studies, 1378 patients, mean difference 3.33 mEq/L, 95% CI, 2.37 to 4.29) and resulted in a slower decline in eGFR (13 studies, 1329 patients, mean difference -3.28 ml/min per 1.73 m2, 95% CI, -4.42 to -2.14; moderate certainty) and a reduction in urinary albumin excretion (very-low certainty), along with a reduction in the risk of progression to ESKD (relative risk, 0.32; 95% CI, 0.18 to 0.56; low certainty). Oral alkali supplementation was associated with worsening hypertension or the requirement for increased antihypertensive therapy (very-low certainty).

CONCLUSIONS:

Low-to-moderate certainty evidence suggest that oral alkali supplementation or a reduction in dietary acid intake may slow the rate of kidney function decline and potentially reduce the risk of ESKD in patients with CKD and metabolic acidosis.

KEYWORDS:

Albumins; Alkalies; Antihypertensive Agents; Bias; Bicarbonates; Confidence Intervals; Kidney Failure, Chronic; Renal Insufficiency, Chronic; Risk Assessment; acidosis; chronic metabolic acidosis; glomerular filtration rate; hypertension; kidney disease; sodium bicarbonate

PMID:
31196951
PMCID:
PMC6625635
[Available on 2020-07-05]
DOI:
10.2215/CJN.13091118

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center