Retarding progression of chronic kidney disease: a preliminary report of the use of oral bicarbonate therapy in a resource limited setting

Abstract

Background: Chronic kidney disease is an established public health priority globally with gloomy outlook in developing countries due to constraints in resources. Acidosis is a major metabolic derangement in chronic kidney disease and its degree correlates with severity of renal failure and its amelioration has been shown to confer benefits by retarding the progression of the disease in a number of reports. We therefore set out to determine the effectiveness of sodium bicarbonate therapy in retarding progression to end-stage kidney failure.

Methodology: This was an open labelled, randomized prospective study of 75 patients with metabolic acidosis. They were randomly assigned to receive either thrice daily oral sodium bicarbonate tablets in the treatment group in addition to the routine medications, the controls were to have routine medications only. The patients’ clinical and biochemical parameters were monitored monthly. The primary renal end points used were the rate of decline of the glomerular filtration and the presence of end stage renal disease.

Result: There were a total of 63 patients with completed results at the end of the study. They comprised of 32 subjects and 31 controls and they were aged between 18-68years. There was a modest increase in the creatinine clearance at the end of the study from 23.8 to 25.4ml/min for the treatment group.14 patients in the control arm progressed to end-stage renal disease while 4 patients amongst the subjects progressed to end stage kidney disease.

Conclusion: Sodium bicarbonate therapy is a potentially useful cost-effective medication in retarding progression to ESKD in developing countries.

Keywords: Retardation, progression, pre-dialytic

Abstrait
Contexte: L’insuffisance rénale chronique est une priorité de santé publique établie dans le monde avec des perspectives sombres dans les pays en voie de développement en raison de contraintes en ressources. L’acidose est un dérangement métabolique majeur dans la maladie rénale chronique et son degré est corrélé à la gravité de l’insuffisance rénale et son amélioration a été démontrée pour conférer des avantages en retardant la progression de la maladie dans un certain nombre d’articles. Nous avons donc cherché à déterminer l’efficacité de la thérapie au bicarbonate de sodium pour retarder la progression vers une insuffisance rénale terminale (IRT).

Méthodologie: Ceci était une étude étiqueté ouverte, prospective randomisée portant sur 75 patients atteints d’acidose métabolique. Ils ont été assignés au hasard pour recevoir trois fois par jour des comprimés de bicarbonate de sodium par voie orale dans le groupe de traitement en plus des médicaments de routine , les témoins devaient avoir des médicaments de routine uniquement. Les paramètres cliniques et biochimiques des patients ont été surveillés mensuellement. Les principaux paramètres rénaux utilisés étaient le taux de déclin de la filtration glomérulaire et la présence d’une maladie rénale en phase terminale.

Résultat: Il y avait un total de 63 patients avec des résultats complets à la fin de l’étude. Ils comprenaient 32 sujets et 31 témoins et ils étaient âgés de 18 à 68 ans. Il y avait une augmentation modeste de la clairance de la créatinine à la fin de l’étude de 23,8 à 25,4 ml / min pour le groupe de traitement. 14 patients du groupe témoin ont progressé vers une insuffisance rénale terminale tandis que 4 patients parmi les sujets ont progressé vers le stade terminal maladie du rein.

Conclusion: La thérapie au bicarbonate de sodium est un médicament potentiellement utile et rentable pour retarder la progression vers l’IRT dans les pays en voie de développement.

Mots clés: Retard, progression, pré- dialyse

Correspondence: Dr.O.O. Okunola, Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. E-mail: yok8t@yahoo.com

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