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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Safety and efficacy of sodium bicarbonate for treating metabolic acidosis in chronic kidney disease: A systematic review and meta-analysis
Abdul Hannan Siddiqui, Fizzah Batool, Shayan Khan, Syed Shabbeer Rizvi, Saad Usman, Huzaifa Jawed, Muhammad Hammad Ali, Tatheer Zehra, Abdul Rafay Adil, Masifah Anwar, Areeba Hanif, Saad Khalid Hassan, Mark William Noble, Abdul Moeed, Salim Surani
Abdul Hannan Siddiqui, Fizzah Batool, Shayan Khan, Syed Shabbeer Rizvi, Saad Usman, Tatheer Zehra, Masifah Anwar, Areeba Hanif, Abdul Moeed, Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Huzaifa Jawed, Department of Internal Medicine, United Medical and Dental College, Karachi 74200, Sindh, Pakistan
Muhammad Hammad Ali, Department of Internal Medicine, Jinnah Sindh Medical University, Karachi 74200, Sindh, Pakistan
Abdul Rafay Adil, Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74200, Sindh, Pakistan
Saad Khalid Hassan, Department of Internal Medicine, Jinnah Medical and Dental College, Karachi 74200, Sindh, Pakistan
Mark William Noble, Department of Medicine, Kings College Hospital London, Dubai 25314, Dubayy, United Arab Emirates
Salim Surani, Department of Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
Author contributions: Siddiqui AH, and Batool F participated in the conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing of the original draft; Khan S, Rizvi SS, Usman S, Jawed H, Ali MH, Zehra T, Adil AR, Anwar M, Hanif A, Hassan SK, Noble MW were involved in data curation, investigation and writing of the original draft; Moeed A and Surani SR were involved in the project administration, supervision, validation, visualization, and writing, review and editing; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Abdul Hannan Siddiqui, MBBS, Doctor, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 74200, Mission Rd, Sindh, Pakistan.
abdul.siddiqui19@dmc.duhs.edu.pk
Received: September 4, 2024
Revised: December 14, 2024
Accepted: January 7, 2025
Published online: March 25, 2025
Processing time: 138 Days and 5.4 Hours
BACKGROUND
Kidney dysfunction and reduced filtration capacity due to chronic kidney disease (CKD) lead to a shift in the body's acid-base balance, ultimately causing metabolic acidosis (MA). Sodium bicarbonate has been used as a supplement to alleviate the symptoms and reverse the acidosis, and it may even slow the progression of CKD. However, its safety profile and overall effectiveness are uncertain.
AIM
To conduct a systematic review and meta-analysis of clinical trials assessing sodium bicarbonate's safety and efficacy for treating CKD-induced MA.
METHODS
Medline, Scopus, EMBASE, and Cochrane Central were systematically searched from inception until May 2024 to select all relevant randomized control trials (RCTs) and non-RCT (NRCTs) evaluating the effectiveness of sodium bicarbonate in correcting MA in end-stage renal disease patients. In addition, ClinicalTrials.gov, Medrxiv.org, and Google Scholar were searched for other literature. A random-effects meta-analysis was performed to derive mean differences (MD) and risk ratios (RR) with their 95%CI for continuous and dichotomous outcomes respectively.
RESULTS
Following a systematic search of the databases, 20 RCTs and 2 and NRCTs comprising 2932 patients were included in our study. The results revealed that sodium bicarbonate significantly increased serum bicarbonate in CKD patients (MD: 2.59, 95%CI: 0.95-4.22; P = 0.02; I2 = 95%). However, there was a non-significant increase in estimated glomerular filtration rate (eGFR) in patients on sodium bicarbonate therapy (MD: 0.93, 95%CI: -1.88-3.75; P = 0.52; I2 = 93%). Upon assessment of the safety profile of sodium bicarbonate, no significant association was found in the outcomes of death/prolonged hospitalization (RR: 1.05, 95%CI: 0.84-1.32; P = 0.66; I2 = 0%), or gastrointestinal disorders (RR: 1.64, 95%CI: 0.35-7.66; P = 0.53; I2 = 76%), or worsening edema (RR: 1.26, 95%CI: 0.94-1.68; P = 0.12; I2 = 37%) when compared to control.
CONCLUSION
Sodium bicarbonate therapy may halt worsening kidney function by correcting serum bicarbonate levels and treating MA. Although sodium bicarbonate does not significantly improve the eGFR, it may potentially prevent CKD progression while maintaining an overall favorable safety profile.
Core Tip: Sodium bicarbonate is a systemic alkalizer that increases serum bicarbonate, buffers hydrogen ions, and raises blood pH, thereby reversing the clinical manifestations of acidosis. It is often prescribed for the treatment of metabolic acidosis (MA) seen in severe renal disease. Studies have been conducted to assess the safety and efficacy of sodium bicarbonate as a pH equalizer. This meta-analysis aims to evaluate the safety profile and clinical efficacy of sodium bicarbonate in treating MA in patients with chronic kidney disease.
