Effect of Treatment of Metabolic Acidosis on Vascular Endothelial Function in Patients with CKD: A Pilot Randomized Cross-Over Study

Clinical Journal of the American Society of Nephrology : CJASN
Jessica KendrickMichel Chonchol

Abstract

We examined the effect of alkali replacement for metabolic acidosis on vascular endothelial function in patients with CKD. We performed a pilot, prospective, open-label 14-week crossover study examining the effect of oral sodium bicarbonate treatment on vascular function in 20 patients with an eGFR of 15-44 ml/min per 1.73 m2 with low serum bicarbonate levels (16-21 mEq/L). Each period was 6 weeks in duration with a 2-week washout period in between. Patients were treated to goal serum bicarbonate of ≥23 mEq/L. The primary end point was change in brachial artery flow-mediated dilation (FMD) between treatment and control conditions. Secondary end points included changes in markers of inflammation, bone turnover, mineral metabolism, and calcification. Eighteen patients completed the study and were included in the primary efficacy analysis. The mean (SD) age and eGFR were 59 (12) years and 26 (8) ml/min per 1.73 m2, respectively. Serum bicarbonate increased significantly with sodium bicarbonate treatment (+2.7±2.9 mEq/L, P≤0.001), whereas there was no change in bicarbonate levels in the control group. FMD significantly improved after sodium bicarbonate therapy (mean±SD, FMD baseline: 4.1%±4.1%; 6 weeks: 5.2%±2.9%; P=0.04) There was...Continue Reading

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Citations

Jun 25, 2019·Current Opinion in Nephrology and Hypertension·Wei Chen, Matthew K Abramowitz
Sep 22, 2018·Clinical Journal of the American Society of Nephrology : CJASN·Matthew K Abramowitz
Dec 19, 2019·Journal of the American Society of Nephrology : JASN·Kalani L RaphaelAlfred K Cheung
Jun 15, 2019·Clinical Journal of the American Society of Nephrology : CJASN·Sankar D NavaneethanDavid A Bushinsky
Jan 29, 2020·Journal of the American Society of Nephrology : JASN·Donald E WessonDavid A Bushinsky
Aug 18, 2020·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Wei ChenRulan S Parekh
Apr 15, 2021·Kidney Medicine·Michal L Melamed, Kalani L Raphael
Jul 13, 2021·Cardiology Clinics·Parta Hatamizadeh

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