Effect of Sodium Bicarbonate on Systolic Blood Pressure in CKD: A Systematic Review and Meta-Analysis

Bano Louca

doi:10.2215/CJN.0000000000000119

Effect of Sodium Bicarbonate on Systolic Blood Pressure in CKD: A Systematic Review and Meta-Analysis

Bano Louca

Twin Research & Genetic Epidemiology

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

Background

Individuals with CKD are at a higher risk of cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic BP. Sodium bicarbonate is an efficacious treatment of acidosis, although this may also increase systolic BP. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic BP and antihypertensive medication change (which may indicate systolic BP change) in response to sodium bicarbonate therapy in individuals with CKD.

Methods

Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) trials registry databases were searched for randomized control trials where sodium bicarbonate was compared with placebo/usual care in CKD stage G1–5 non–dialysis-dependent populations. Random effects meta-analyses were used to evaluate changes in systolic BP and BP-modifying drugs after sodium bicarbonate intervention.

Results

Fourteen randomized control trials (2110 individuals, median follow-up 27 [interquartile range 97] weeks, mean age 60 [SD 10] years, mean systolic BP 136 [SD 17] mm Hg, mean eGFR 38 [SD 10] ml/min, mean serum bicarbonate 22 [SD 4] mmol/L) were eligible for inclusion. Meta-analysis suggested that sodium bicarbonate did not influence systolic BP in individuals with CKD stage G1–5. Results were consistent when stratifying by dose of sodium bicarbonate or duration of intervention. Similarly, there was no significant increase in the use of antihypertensive medication or diuretics in individuals taking sodium bicarbonate, whereas there was a greater decrease in antihypertensive medication use in individuals taking sodium bicarbonate compared with controls.

Conclusions

Our results suggest, with moderate certainty, that sodium bicarbonate supplementation does not adversely affect systolic BP in CKD or negatively influence antihypertensive medication requirements.

Original language	English
Pages (from-to)	435-445
Number of pages	11
Journal	Clinical journal of the American Society of Nephrology : CJASN
Volume	18
Issue number	4
DOIs	https://doi.org/10.2215/CJN.0000000000000119
Publication status	Published - 9 Feb 2023

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10.2215/CJN.0000000000000119

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title = "Effect of Sodium Bicarbonate on Systolic Blood Pressure in CKD: A Systematic Review and Meta-Analysis",

abstract = "Background Individuals with CKD are at a higher risk of cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic BP. Sodium bicarbonate is an efficacious treatment of acidosis, although this may also increase systolic BP. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic BP and antihypertensive medication change (which may indicate systolic BP change) in response to sodium bicarbonate therapy in individuals with CKD.Methods Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) trials registry databases were searched for randomized control trials where sodium bicarbonate was compared with placebo/usual care in CKD stage G1–5 non–dialysis-dependent populations. Random effects meta-analyses were used to evaluate changes in systolic BP and BP-modifying drugs after sodium bicarbonate intervention.Results Fourteen randomized control trials (2110 individuals, median follow-up 27 [interquartile range 97] weeks, mean age 60 [SD 10] years, mean systolic BP 136 [SD 17] mm Hg, mean eGFR 38 [SD 10] ml/min, mean serum bicarbonate 22 [SD 4] mmol/L) were eligible for inclusion. Meta-analysis suggested that sodium bicarbonate did not influence systolic BP in individuals with CKD stage G1–5. Results were consistent when stratifying by dose of sodium bicarbonate or duration of intervention. Similarly, there was no significant increase in the use of antihypertensive medication or diuretics in individuals taking sodium bicarbonate, whereas there was a greater decrease in antihypertensive medication use in individuals taking sodium bicarbonate compared with controls.Conclusions Our results suggest, with moderate certainty, that sodium bicarbonate supplementation does not adversely affect systolic BP in CKD or negatively influence antihypertensive medication requirements.",

author = "Bano Louca",

note = "Funding Information: B. Beynon-Cobb reports employment with UHCW NHS Trust. UHCW NHS Trust has received honoraria for the following which B. Beynon-Cobb undertook: September 2022: Presentations at the British Renal Pharmacy Group Meeting in September 2022 supported by Stanningley Pharma (Subject5treatment of acidosis in CKD), and July 2022: Presentation to Stanningley Pharma (Subject5treatment of acidosis in CKD). E.J. Hoorn reports employment with Erasmus Medical Center; research funding from Aurinia; honoraria from UpToDate; serving on the Editorial Boards of JASN, the Journal of Nephrology, and the American Journal of Physiology—Renal Physiology; and serving as a Board Member of the ERA Working Group on Inherited Kidney Diseases and as a Board Member of the Dutch Federation of Nephrology. C. Menni reports research funding from the Chronic Disease Research Foundation. All remaining authors have nothing to disclose. Funding Information: B. Beynon-Cobb was funded by a CRN West Midlands Personal Development Award and the Center for Care Excellence at UHCW NHS Trust. P. Louca was supported by the Chronic Disease Research Foundation (CDRF–15/2018). C. Menni was funded by the Chronic Disease Research Foundation (CDRF) and by the MRC Aim-Hy project grant. S. Padmanabhan was funded by the British Heart Foundation (BHF CS/16/1/31878; RE/18/ 6/34217). Stanningley Pharma supported open access publication of this manuscript. Publisher Copyright: {\textcopyright} 2023 The Authors. Published by Wolters Kluwer Health, Inc.",

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doi = "10.2215/CJN.0000000000000119",

language = "English",

volume = "18",

pages = "435--445",

journal = "Clinical journal of the American Society of Nephrology : CJASN",

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T1 - Effect of Sodium Bicarbonate on Systolic Blood Pressure in CKD: A Systematic Review and Meta-Analysis

AU - Louca, Bano

N1 - Funding Information: B. Beynon-Cobb reports employment with UHCW NHS Trust. UHCW NHS Trust has received honoraria for the following which B. Beynon-Cobb undertook: September 2022: Presentations at the British Renal Pharmacy Group Meeting in September 2022 supported by Stanningley Pharma (Subject5treatment of acidosis in CKD), and July 2022: Presentation to Stanningley Pharma (Subject5treatment of acidosis in CKD). E.J. Hoorn reports employment with Erasmus Medical Center; research funding from Aurinia; honoraria from UpToDate; serving on the Editorial Boards of JASN, the Journal of Nephrology, and the American Journal of Physiology—Renal Physiology; and serving as a Board Member of the ERA Working Group on Inherited Kidney Diseases and as a Board Member of the Dutch Federation of Nephrology. C. Menni reports research funding from the Chronic Disease Research Foundation. All remaining authors have nothing to disclose. Funding Information: B. Beynon-Cobb was funded by a CRN West Midlands Personal Development Award and the Center for Care Excellence at UHCW NHS Trust. P. Louca was supported by the Chronic Disease Research Foundation (CDRF–15/2018). C. Menni was funded by the Chronic Disease Research Foundation (CDRF) and by the MRC Aim-Hy project grant. S. Padmanabhan was funded by the British Heart Foundation (BHF CS/16/1/31878; RE/18/ 6/34217). Stanningley Pharma supported open access publication of this manuscript. Publisher Copyright: © 2023 The Authors. Published by Wolters Kluwer Health, Inc.

PY - 2023/2/9

Y1 - 2023/2/9

N2 - Background Individuals with CKD are at a higher risk of cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic BP. Sodium bicarbonate is an efficacious treatment of acidosis, although this may also increase systolic BP. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic BP and antihypertensive medication change (which may indicate systolic BP change) in response to sodium bicarbonate therapy in individuals with CKD.Methods Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) trials registry databases were searched for randomized control trials where sodium bicarbonate was compared with placebo/usual care in CKD stage G1–5 non–dialysis-dependent populations. Random effects meta-analyses were used to evaluate changes in systolic BP and BP-modifying drugs after sodium bicarbonate intervention.Results Fourteen randomized control trials (2110 individuals, median follow-up 27 [interquartile range 97] weeks, mean age 60 [SD 10] years, mean systolic BP 136 [SD 17] mm Hg, mean eGFR 38 [SD 10] ml/min, mean serum bicarbonate 22 [SD 4] mmol/L) were eligible for inclusion. Meta-analysis suggested that sodium bicarbonate did not influence systolic BP in individuals with CKD stage G1–5. Results were consistent when stratifying by dose of sodium bicarbonate or duration of intervention. Similarly, there was no significant increase in the use of antihypertensive medication or diuretics in individuals taking sodium bicarbonate, whereas there was a greater decrease in antihypertensive medication use in individuals taking sodium bicarbonate compared with controls.Conclusions Our results suggest, with moderate certainty, that sodium bicarbonate supplementation does not adversely affect systolic BP in CKD or negatively influence antihypertensive medication requirements.

AB - Background Individuals with CKD are at a higher risk of cardiovascular morbidity and mortality. Acidosis is positively correlated with CKD progression and elevated systolic BP. Sodium bicarbonate is an efficacious treatment of acidosis, although this may also increase systolic BP. In this systematic review and meta-analysis, we summarize the evidence evaluating systolic BP and antihypertensive medication change (which may indicate systolic BP change) in response to sodium bicarbonate therapy in individuals with CKD.Methods Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) trials registry databases were searched for randomized control trials where sodium bicarbonate was compared with placebo/usual care in CKD stage G1–5 non–dialysis-dependent populations. Random effects meta-analyses were used to evaluate changes in systolic BP and BP-modifying drugs after sodium bicarbonate intervention.Results Fourteen randomized control trials (2110 individuals, median follow-up 27 [interquartile range 97] weeks, mean age 60 [SD 10] years, mean systolic BP 136 [SD 17] mm Hg, mean eGFR 38 [SD 10] ml/min, mean serum bicarbonate 22 [SD 4] mmol/L) were eligible for inclusion. Meta-analysis suggested that sodium bicarbonate did not influence systolic BP in individuals with CKD stage G1–5. Results were consistent when stratifying by dose of sodium bicarbonate or duration of intervention. Similarly, there was no significant increase in the use of antihypertensive medication or diuretics in individuals taking sodium bicarbonate, whereas there was a greater decrease in antihypertensive medication use in individuals taking sodium bicarbonate compared with controls.Conclusions Our results suggest, with moderate certainty, that sodium bicarbonate supplementation does not adversely affect systolic BP in CKD or negatively influence antihypertensive medication requirements.

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DO - 10.2215/CJN.0000000000000119

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JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

IS - 4

ER -

Effect of Sodium Bicarbonate on Systolic Blood Pressure in CKD: A Systematic Review and Meta-Analysis

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