Kidney Week

Abstract: FR-PO977

Effect of Sodium Bicarbonate Treatment on Cognitive Function in CKD

Session Information

• CKD Interventions: Trials and Quality Improvement
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Kendrick, Jessica B., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Jessica B. Kendrick,

• Bjornstad, Petter, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Petter Bjornstad,

• You, Zhiying, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Zhiying You,

• Shapiro, Allison, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Allison Shapiro,

• Furgeson, Seth B., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Seth B. Furgeson,

Background

Cognitive impairment, prevalent in adults with chronic kidney disease (CKD), contributes to mortality, functional decline, depression, frailty, and diminished quality of life. Lower serum bicarbonate levels, even within normal parameters, associate with cognitive impairment in CKD. However, the effect of sodium bicarbonate (NaHCO₃) supplementation on cognitive function in CKD is not known. We examined the effect of NaHCO₃ therapy on cognitive function in patients with CKD stage 3B-4.

Methods

We performed an ancillary study using participants in the Bicarbonate Administration in CKD Trial, which was a randomized prospective, double-blind, placebo-controlled trial of 109 participants with CKD stage 3B-4 (eGFR 15-44 ml/min/1.73m²) with serum bicarbonate levels 22-27 mEq/L. Participants were randomly assigned to receive either NaHCO₃ or placebo at a dose of 0.5 mEq/LBW-kg/day for 12 months. Cognitive function was measured at baseline and 12 months using the National Institutes of Health Toolbox® (NIH-TB) cognitive battery, which assesses fluid cognition (e.g., executive and memory function) and crystallized cognition (e.g., language skills).

Results

90 patients (50.4% female) with a mean (SD) age of 61.7 ± 11.6 years and eGFR of 35.9 ± 9.8 ml/min/1.73m² completed the study. The mean (SD) serum bicarbonate level at baseline was 23.4 ± 2.2 mEq/L. After 12 months, serum bicarbonate levels increased, on average, 1.35 mEq/L (95% CI: 0.34-2.36, p=0.003) in the NaHCO₃ group compared to placebo. Both the NaHCO₃ and placebo groups had a significant increase in fluid cognition scores after 12 months, but there was no significant difference between the groups (Figure). NaHCO₃ therapy did not result in a significant improvement in crystallized or total cognition. NaHCO₃ therapy was safe and well-tolerated with no significant changes in blood pressure, anti-hypertensive medication, weight, calcium or potassium levels.

Conclusion

Twelve months of NaHCO₃ therapy in patients with moderate to advanced CKD and normal serum bicarbonate levels did not improve cognitive function.

Funding

• Other NIH Support