Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Abstract

Background: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD) and metabolic acidosis might accelerate vascular calcification. The T₅₀ calcification inhibition test (T₅₀-test) is a global functional test analyzing the overall propensity of calcification in serum, and low T₅₀-time is associated with progressive aortic stiffening and with all-cause mortality in non-dialysis CKD, dialysis, and transplant patients. Low serum bicarbonate is associated with a short T₅₀-time and alkali supplementation could be a simple modifier of calcification propensity. The aim of this study was to investigate the short-term effect of oral sodium bicarbonate supplementation on T₅₀-time in CKD patients. Material and Methods: The SoBic-study is an ongoing randomized-controlled trial in CKD-G3 and G4 patients with chronic metabolic acidosis (serum HCO₃^– ≤21 mmol/L), in which patients are randomized to either achieve serum HCO₃^– levels of 24 ± 1 mmol/L (intervention group) or 20 ± 1 mmol/L (rescue group). The effect of bicarbonate treatment on T₅₀-time was assessed. Results: The study cohort consisted of 35 (14 female) patients aged 57 (±15) years, and 18 were randomized to the intervention group. The mean T₅₀-time was 275 (± 64) min. After 4 weeks, the mean change of T₅₀-time was 4 (±69) min in the intervention group and 18 min (±56) in the rescue group (β = –25; 95% CI: –71 to 22; p = 0.298). Moreover, change of serum bicarbonate in individual patients was not associated with change in T₅₀-time, analyzed by regression analysis. Change of serum phosphate had a significant impact on change of T₅₀-time (β = –145; 95% CI: –237 to –52). Conclusion: Oral sodium bicarbonate supplementation showed no effect on T₅₀-time in acidotic CKD patients.

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

“… 30 , 31 Current guidelines recommend treatment of MA in CKD with sodium (Na + )-based alkali, such as sodium bicarbonate. 32 The association of MA with CKD progression and poor kidney function has been widely reported. 27 , 33 An adverse effect of long-term sodium bicarbonate supplementation in patients with CKD is sodium mediated fluid retention, resulting in weight gain, peripheral edema, elevated blood pressure and even heart failure.…”

Effect of Oral Sodium Bicarbonate Treatment on 24-Hour Ambulatory Blood Pressure Measurements in Patients With Chronic Kidney Disease and Metabolic Acidosis

“…Further indicators of cardiovascular risk as well-improved in the dietary group ( 34 ). However, whether sodium bicarbonate supplementation ameliorates cardiovascular outcomes ought to be shown ( 38 , 39 ).…”

Calciprotein Particles

“…Nonetheless, validation by independent groups of the association between a decreased one-half maximal transition time and the occurrence of pathology are appearing in literature. 199,200 A recently introduced flow cytometry-based technique allows for direct quantification of CPPs in serum and other biofluids (Figure 2D), which may be translated into routine clinical diagnostics. In this protocol, CPP and membranous extracellular vesicles are separated from other cellular particulates by size-exclusion or ultracentrifugation and further characterized by a combination of a fluorescently labeled bisphosphonate (OsteoSense 680EX) that labels mineral deposits and a green fluorescent membrane-intercalating dye (PKH67) that labels membranous structures.…”

“…Nonetheless, validation by independent groups of the association between a decreased one-half maximal transition time and the occurrence of pathology are appearing in literature. 199,200…”