AUTHOR=Wu Yun , Wang Ying , Huang Weijun , Guo Xi , Hou Baoluo , Tang Jingyi , Wu Yuqi , Zheng Huijuan , Pan Yanling , Liu Wei Jing 

TITLE=Efficacy and safety of oral sodium bicarbonate in kidney-transplant recipients and non-transplant patients with chronic kidney disease: a systematic review and meta-analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1411933

DOI=10.3389/fphar.2024.1411933

ISSN=1663-9812

ABSTRACT=<sec><title>Introduction</title><p>We investigated the efficacy and safety of oral sodium bicarbonate in kidney-transplant recipients and non-transplant patients with chronic kidney disease (CKD), which are currently unclear.</p></sec><sec><title>Methods</title><p>PubMed, Cochrane Library, Embase, and Web of Science were searched for randomized controlled trials investigating the efficacy and safety of sodium bicarbonate <italic>versus</italic> placebo or standard treatment in kidney-transplant and non-transplant patients with CKD.</p></sec><sec><title>Results</title><p>Sixteen studies of kidney-transplant recipients (two studies, 280 patients) and non-transplant patients with CKD (14 studies, 1,380 patients) were included. With non-transplant patients, sodium bicarbonate slowed kidney-function declines (standardized mean difference [SMD]: 0.49, 95% confidence interval [CI]: 0.14–0.85, <italic>p</italic> = 0.006) within ≥12 months (SMD: 0.75 [95% CI: 0.12–1.38], <italic>p</italic> = 0.02), baseline-serum bicarbonate &lt;22 mmol/L (SMD: 0.41 [95% CI: 0.19–0.64], <italic>p</italic> = 0.0004) and increased serum-bicarbonate levels (mean difference [MD]: 2.35 [95% CI: 1.40–3.30], <italic>p</italic> &lt; 0.00001). In kidney-transplant recipients, sodium bicarbonate did not preserve graft function (SMD: -0.07 [95% CI: -0.30–0.16], <italic>p</italic> = 0.56) but increased blood pH levels (MD: 0.02 [95% CI: 0.00–0.04], <italic>p</italic> = 0.02). No significant adverse events occurred in the kidney-transplant or non-transplant patients (risk ratio [RR]: 0.89, [95% CI: 0.47–1.67], <italic>p</italic> = 0.72; and RR 1.30 [95% CI: 0.84–2.00], <italic>p</italic> = 0.24, respectively). However, oral sodium bicarbonate correlated with increased diastolic pressure and worsened hypertension and edema (MD: 2.21 [95% CI: 0.67–3.75], <italic>p</italic> = 0.005; RR: 1.44 [95% CI: 1.11–1.88], <italic>p</italic> = 0.007; and RR: 1.28 [95% CI: 1.00–1.63], <italic>p</italic> = 0.05, respectively).</p></sec><sec><title>Discussion</title><p>Oral sodium bicarbonate may slow kidney-function decline in non-transplant patients with CKD taking sodium bicarbonate supplementation for ≥12 months or a baseline serum bicarbonate level of &lt;22 mmol/L, without preserving graft function in kidney-transplant recipients. Sodium bicarbonate may increase diastolic pressure, and elevate a higher incidence of worsening hypertension and edema.</p></sec><sec><title>Systematic Review Registration:</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>, identifier CRD42023413929.</p></sec>