Key result
Oral sodium bicarbonate linked to ~5% lower major cardiovascular events risk and reduced mortality in advanced CKD.
Why the study?
Information was limited regarding the effect of sodium bicarbonate on major adverse cardiovascular events and mortality in patients with pre-dialysis advanced CKD.
Does sodium bicarbonate reduce MACE, mortality, and dialysis initiation in patients with advanced CKD stage V?
Cohort (n=25,599)
Yes
Does sodium bicarbonate reduce MACE, mortality, and dialysis initiation in patients with advanced CKD stage V?
In real-world practice, oral sodium bicarbonate use in patients with advanced CKD stage V is associated with reduced risks of MACE and all-cause mortality, without significantly affecting the risk of dialysis initiation.
Answers are grounded in this paper and cite their sources.
Associated lower MACE/mortality risks in advanced CKD but neutral on dialysis; hypothesis-generating, needs RCTs before practice change.
Background: Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD). Oral sodium bicarbonate is often used to treat metabolic acidosis and prevent CKD progression. However, there is limited information about the effect of sodium bicarbonate on major adverse cardiovascular events (MACE) and mortality in patients with pre-dialysis advanced CKD. Method: 25599 patients with CKD stage V between January 1, 2001 and December 31, 2019 were identified from the Chang Gung Research Database (CGRD), a multi-institutional electronic medical record database in Taiwan. The exposure was defined as receiving sodium bicarbonate or not. Baseline characteristics were balanced using propensity score weighting between two groups. Primary outcomes were dialysis initiation, all-cause mortality, and major adverse cardiovascular events (MACE) (myocardial infarction, heart failure, stroke). The risks of dialysis, MACE, and mortality were compared between two groups using Cox proportional hazards models. In addition, we performed analyzes using Fine and Gray sub-distribution hazard models that considered death as a competing risk. Result: Among 25599 patients with CKD stage V, 5084 patients (19.9%) were sodium bicarbonate users while 20515 (80.1%) were sodium bicarbonate non-users. The groups had similar risk of dialysis initiation (hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.95-1.02, p < 0.379). However, taking sodium bicarbonate was associated with a significantly lower risks of MACE (HR: 0.95, 95% CI 0.92–0.98, p < 0.001) and hospitalizations for acute pulmonary edema (HR: 0.92, 95% CI 0.88–0.96, p < 0.001) compared with non-users. The mortality risks were significantly lower in sodium bicarbonate users compared with sodium bicarbonate non-users (HR: 0.75, 95% CI 0.74–0.77, p < 0.001). Conclusion: This cohort study revealed that in real world practice, use of sodium bicarbonate was associated with similar risk of dialysis compared with non-users among patients with advanced CKD stage V. Nonetheless, use of sodium bicarbonate was associated with significantly lower rate of MACE and mortality. Findings reinforce the benefits of sodium bicarbonate therapy in the expanding CKD population. Further prospective studies are needed to confirm these findings.
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Cheng et al. (2023) conducted a cohort in Advanced chronic kidney disease (CKD stage V) (n=25,599). Oral sodium bicarbonate vs. Sodium bicarbonate non-users was evaluated on Major adverse cardiovascular events (MACE) (HR 0.95, 95% CI 0.92-0.98, p=<0.001). Oral sodium bicarbonate use was associated with a lower risk of major adverse cardiovascular events and mortality compared to non-users in patients with advanced chronic kidney disease.
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