Abstract: SA-PO495
Oral Sodium Bicarbonate in Patients on Maintenance Hemodialysis: A Systematic Review and Meta-Analysis
Session Information
- Acid-Base, Calcium, Potassium, and Magnesium Disorders: Clinical
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Santos, Adrian Lucas, Philippine General Hospital, Manila, Metro Manila, Philippines
- Villavicencio, Jayson M., Philippine General Hospital, Manila, Metro Manila, Philippines
- Sta. Maria, Maxine Camela Sy, Philippine General Hospital, Manila, Metro Manila, Philippines
Background
Metabolic acidosis, one of the complications of chronic kidney disease (CKD), can lead to malnutrition and increased protein catabolism. Oral sodium bicarbonate supplements have been used to address this consequence among non-dialytic CKD patients. However, the evidence of their continued use among patients already on regular maintenance hemodialysis is still the subject of many studies. This study aims to determine the effect of oral sodium bicarbonate supplements on the nutritional status and interdialytic potassium gain of CKD patients on maintenance hemodialysis.
Methods
Searches for eligible studies were done on PubMed, ProQuest, the Cochrane Library, and ClinicalTrial.gov until December 2023. Studies included were randomized controlled trials of CKD patients on maintenance hemodialysis given oral sodium bicarbonate supplements. The primary outcome is change in nutritional status which was assessed by different parameters, while the secondary outcome of interest is interdialytic potassium gain. Three reviewers independently screened the studies and assessed the quality using the Cochrane RoB tool. Random-effects meta-analysis was done using Review Manager 5.4.
Results
Two studies, both moderate quality RCTs, were included in this review, involving a total of 93 patients. The parameters employed for the assessment of nutritional status included normalized protein catabolic rate (nPCR), interdialytic weight gain, and handgrip. Pooled analysis showed that sodium bicarbonate was as effective or better in terms of in nPCR, mean difference 0.09 g/kg/day (95% CI -0.05 to 0.23, I2=37%; associated with an increase in interdialytic weight gain compared to control, mean difference of 0.43 kg (95% CI 0.01 to 0.84, I2=39%), and as effective compared to control (no sodium bicarbonate) in terms of improving handgrip, mean difference of 3.57 kg (95% CI -10.72 to 17.85, I2=80%). The sodium bicarbonate group also showed lower levels of pre-dialysis potassium, mean difference of 0.33 mmol/L (95% CI -0.58 to -0.11, I2 = 0%).
Conclusion
There is low certainty of evidence to suggest that oral sodium bicarbonate supplementation among patients on hemodialysis may result in a slight improvement in the nutrition and interdialytic potassium gain of these patients.