Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

Table 2

Relationship between metabolic acidosis and kidney disease progression.

Type of study	Patients; number	Main finding	Limitations	Reference
Retrospective	5,422	Weak association between low serum bicarbonate and progression of kidney disease	Only 9% of the participants have estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m^2 at baseline; The estimation of progression of kidney disease is very limited	Shah et al., 2009 [67]
Retrospective	1,094	Higher serum bicarbonate is associated with reduced hazard of kidney disease progression	It is a secondary analysis; Limited external validity	Raphael et al., 2011 [68]
Prospective, multicenter cohort	3,939	The risk of disease progression is 3% lower per 1 mM increase in serum bicarbonate level	Hazard ratio 0.97, 95% confidence interval 0.94–0.99	Dobre et al., 2013 [51]
Retrospective	113	Lower bicarbonate level is associated with high risk of kidney disease progression	At baseline, patients in the low-bicarbonate group have strikingly more impaired kidney function compared to patients in the high-bicarbonate group; Small sample size; High number of censored observations	Kanda et al., 2013 [70]
Retrospective	1,073	There is no significant association between lower bicarbonate level and incident eGFR <60 mL/min/1.73 m^2	Serum bicarbonate level was calculated from the Henderson-Hasselbalch equation	Goldenstein et al., 2014 [71]
Retrospective	5,810	Serum bicarbonate categories are not associated with adjusted risk of incident eGFR <60 mL/min/1.73 m^2	Total serum carbon dioxide was measured at baseline in serum samples long-term stored	Driver et al., 2014 [72]
Retrospective	632	No clear association between higher quartiles of net endogenous acid production (NEAP) and faster decline in GFR over follow-up	Higher quartiles of NEAP are associated with a faster decline in GFR, but there is no association in time-to-event analyses	Scialla et al., 2012 [69]