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A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial.

Publication ,  Journal Article
Raphael, KL; Isakova, T; Ix, JH; Raj, DS; Wolf, M; Fried, LF; Gassman, JJ; Kendrick, C; Larive, B; Flessner, MF; Mendley, SR; Hostetter, TH ...
Published in: J Am Soc Nephrol
January 2020

BACKGROUND: Oral sodium bicarbonate (NaHCO3) may preserve kidney function in CKD, even if initiated when serum bicarbonate concentration is normal. Adequately powered trials testing this hypothesis have not been conducted, partly because the best dose for testing is unknown. METHODS: This multicenter pilot trial assessed the safety, tolerability, adherence, and pharmacodynamics of two doses of NaHCO3 over 28 weeks in adults with eGFR 20-44 or 45-59 ml/min per 1.73 m2 with urinary albumin/creatinine (ACR) ≥50 mg/g and serum bicarbonate 20-28 meq/L. We randomly assigned 194 participants from ten clinical sites to receive higher-dose (HD-NaHCO3; 0.8 meq/kg of lean body wt per day; n=90) or lower-dose (LD-NaHCO3; 0.5 meq/kg of lean body wt per day; n=52) NaHCO3 or matching placebo (n=52). The dose was adjusted depending on side effects. The prescribed dose at week 28 was the primary outcome; a dose was considered acceptable for a full-scale trial if ≥67% of participants were on full-dose and ≥80% were on ≥25% of the per-protocol dose. RESULTS: Mean±SD baseline eGFR was 36±9 ml/min per 1.73 m2, serum bicarbonate was 24±2 meq/L, and median (IQR) ACR was 181 (25-745) mg/g. Both doses were well tolerated without significant changes in BP, weight, or serum potassium. The proportions of adverse events and hospitalizations were similar across the groups. Consequently, 87% in HD-NaHCO3, 96% in LD-NaHCO3, and 87% in placebo were on full dose at week 28; and 91% in HD-NaHCO3, 98% in LD-NaHCO3, and 92% in placebo were on ≥25% of the per-protocol dose. Mean urinary ammonium excretion was 25% lower and serum bicarbonate concentration was 1.3 meq/L higher in HD-NaHCO3 compared with LD-NaHCO3 at week 28. However, mean ACR increased by 12% in the lower-dose group and 30% in the higher-dose group. CONCLUSIONS: Both NaHCO3 doses were well tolerated over 28 weeks with no significant difference in adverse events or hospitalization compared with placebo. The higher dose lowered urinary ammonium excretion and increased serum bicarbonate more than the lower dose but was associated with a greater increase in ACR. The higher 0.8 meq/kg of lean body wt per day dose of NaHCO3 may be a reasonable choice for future trials.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

January 2020

Volume

31

Issue

1

Start / End Page

161 / 174

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sodium Bicarbonate
  • Renal Insufficiency, Chronic
  • Pilot Projects
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • Female
  • Aged, 80 and over
 

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Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., … Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. J Am Soc Nephrol, 31(1), 161–174. https://doi.org/10.1681/ASN.2019030287
Raphael, Kalani L., Tamara Isakova, Joachim H. Ix, Dominic S. Raj, Myles Wolf, Linda F. Fried, Jennifer J. Gassman, et al. “A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial.J Am Soc Nephrol 31, no. 1 (January 2020): 161–74. https://doi.org/10.1681/ASN.2019030287.
Raphael KL, Isakova T, Ix JH, Raj DS, Wolf M, Fried LF, et al. A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. J Am Soc Nephrol. 2020 Jan;31(1):161–74.
Raphael, Kalani L., et al. “A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial.J Am Soc Nephrol, vol. 31, no. 1, Jan. 2020, pp. 161–74. Pubmed, doi:10.1681/ASN.2019030287.
Raphael KL, Isakova T, Ix JH, Raj DS, Wolf M, Fried LF, Gassman JJ, Kendrick C, Larive B, Flessner MF, Mendley SR, Hostetter TH, Block GA, Li P, Middleton JP, Sprague SM, Wesson DE, Cheung AK. A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. J Am Soc Nephrol. 2020 Jan;31(1):161–174.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

January 2020

Volume

31

Issue

1

Start / End Page

161 / 174

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Sodium Bicarbonate
  • Renal Insufficiency, Chronic
  • Pilot Projects
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • Female
  • Aged, 80 and over