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A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial.
Raphael, Kalani L; Isakova, Tamara; Ix, Joachim H; Raj, Dominic S; Wolf, Myles; Fried, Linda F; Gassman, Jennifer J; Kendrick, Cynthia; Larive, Brett; Flessner, Michael F; Mendley, Susan R; Hostetter, Thomas H; Block, Geoffrey A; Li, Ping; Middleton, John P; Sprague, Stuart M; Wesson, Donald E; Cheung, Alfred K.
Affiliation
  • Raphael KL; Department of Internal Medicine, University of Utah Health and Renal Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; kalani.raphael@hsc.utah.edu.
  • Isakova T; Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
  • Ix JH; Department of Medicine, University of California San Diego and Renal Section, Veterans Affairs San Diego Healthcare System, San Diego, California.
  • Raj DS; Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC.
  • Wolf M; Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
  • Fried LF; Department of Medicine, University of Pittsburgh and Renal Section, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania.
  • Gassman JJ; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.
  • Kendrick C; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.
  • Larive B; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.
  • Flessner MF; Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
  • Mendley SR; Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
  • Hostetter TH; Department of Medicine, Case Western Reserve Hospitals, Cleveland, Ohio.
  • Block GA; Denver Nephrology, Denver, Colorado.
  • Li P; Renal Section, Veterans Affairs Washington, DC Health Care System, Washington, DC.
  • Middleton JP; Division of Nephrology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
  • Sprague SM; Department of Medicine, Northshore University Health System, University of Chicago, Evanston, Illinois; and.
  • Wesson DE; Health and Wellness Center, Baylor Scott & White Health, Dallas, Texas.
  • Cheung AK; Department of Internal Medicine, University of Utah Health and Renal Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
J Am Soc Nephrol ; 31(1): 161-174, 2020 01.
Article in En | MEDLINE | ID: mdl-31848294
ABSTRACT

BACKGROUND:

Oral sodium bicarbonate (NaHCO3) may preserve kidney function in CKD, even if initiated when serum bicarbonate concentration is normal. Adequately powered trials testing this hypothesis have not been conducted, partly because the best dose for testing is unknown.

METHODS:

This multicenter pilot trial assessed the safety, tolerability, adherence, and pharmacodynamics of two doses of NaHCO3 over 28 weeks in adults with eGFR 20-44 or 45-59 ml/min per 1.73 m2 with urinary albumin/creatinine (ACR) ≥50 mg/g and serum bicarbonate 20-28 meq/L. We randomly assigned 194 participants from ten clinical sites to receive higher-dose (HD-NaHCO3; 0.8 meq/kg of lean body wt per day; n=90) or lower-dose (LD-NaHCO3; 0.5 meq/kg of lean body wt per day; n=52) NaHCO3 or matching placebo (n=52). The dose was adjusted depending on side effects. The prescribed dose at week 28 was the primary outcome; a dose was considered acceptable for a full-scale trial if ≥67% of participants were on full-dose and ≥80% were on ≥25% of the per-protocol dose.

RESULTS:

Mean±SD baseline eGFR was 36±9 ml/min per 1.73 m2, serum bicarbonate was 24±2 meq/L, and median (IQR) ACR was 181 (25-745) mg/g. Both doses were well tolerated without significant changes in BP, weight, or serum potassium. The proportions of adverse events and hospitalizations were similar across the groups. Consequently, 87% in HD-NaHCO3, 96% in LD-NaHCO3, and 87% in placebo were on full dose at week 28; and 91% in HD-NaHCO3, 98% in LD-NaHCO3, and 92% in placebo were on ≥25% of the per-protocol dose. Mean urinary ammonium excretion was 25% lower and serum bicarbonate concentration was 1.3 meq/L higher in HD-NaHCO3 compared with LD-NaHCO3 at week 28. However, mean ACR increased by 12% in the lower-dose group and 30% in the higher-dose group.

CONCLUSIONS:

Both NaHCO3 doses were well tolerated over 28 weeks with no significant difference in adverse events or hospitalization compared with placebo. The higher dose lowered urinary ammonium excretion and increased serum bicarbonate more than the lower dose but was associated with a greater increase in ACR. The higher 0.8 meq/kg of lean body wt per day dose of NaHCO3 may be a reasonable choice for future trials.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sodium Bicarbonate / Renal Insufficiency, Chronic / Medication Adherence Type of study: Clinical_trials / Guideline Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: J Am Soc Nephrol Journal subject: NEFROLOGIA Year: 2020 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sodium Bicarbonate / Renal Insufficiency, Chronic / Medication Adherence Type of study: Clinical_trials / Guideline Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: J Am Soc Nephrol Journal subject: NEFROLOGIA Year: 2020 Document type: Article