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

Authors

  • OO Okunola
  • A Akinsola
  • FA Arogundade
  • AA Sanusi

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

References

El Nahas AM, Bello AK: Chronic kidney disease: the global challenge. Lancet 2005;365:331-340

Oluyombo R, Ayodele OE, Akinwusi PO et al. A community study of the prevalence, risk factors and pattern of chronic kidney disease in Osun State. Nigeria. WAJM 2013. 32(2):86-92

Akinsola W, Odesanmi WO, Oguniyi J et al. Disease causing renal failure in Nigerians- a prospective study of 100 cases. Afr J Med Med sci 1989; 18 : 131-137

Bamgboye EL. End stage renal disease in Sub Saharan Africa. Ethn Dis 2006; 16 (2 suppl 2 ) : S2-S9

Alebiosu CO, Ayodele OO and Abbas A. Chronic renal failure at the Olabisi Onabanjo University Teaching , Sagamu, Nigeria. African health sciences 2006; 6(3): 132-138.

Bailey JL. Metabolic acidosis: An unrecognized cause of morbidity in the patient with chronic kidney disease. Kid Int 2005: (S96); pp S15-S23

McSherry E and Morris RC Jr: Attainment of normal stature with alkali therapy in infants and chidren with classic renal tubular acidosis. J Clin Invest 1978; 61: 509-527.

Pickering WP, Price SR, Bircher G et al. Nutrition in CAPD: serum bicarbonate and the ubiquitin-proteasome system in muscle. Kidney Int. 2002; 61: 1286-1292.

Movilli E, Zani R, Carli O et al. Correction of metabolic acidosis increases serum albumin concentrations and reduces kinetically evaluated protein intake in heamodialysis patients: a prospective study. Nephrol Dial Transpl 1998; 13:1719-1722.

Bushinski DA; The contribution of acidosis to renal osteodystrophy. Kidney Int 1995;47: 1816-1832.

Lyon DM, Dunlop DM and Stewart CP: The alkaline treatment of chronic nephritis. Lancet 1931;2 :1009-1013.

Mahajan A, Simoni J, Sheather SJ et al. Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy. Kidney Int 2010; 78 (3): 303-309.

Gadola L Noboa O, Marquez MN et al. Calcium citrate ameliorates the progression of chronic renal injury. Kidney Int. 2004; 65:1224-1230.

Brito- AshurstId, Varagunam M and RafteryMJ. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 2009; 20:2075-2084.

Susantitaphong P, Sewaralthahab K, Balk EM et al. Short and long term effects of alkali therapy in Chronic Kidney Disease: A systematic Review. Am J Nephrol 2012; 35:540-547.

Alebiosu CO and Ayodele OE. The increasing prevalence of diabetic nephropathy as a cause of ESRD in Nigeria. Tropical Doctor 2006; 36:218-219.

McCain L. Pocket guide to the nutritional assessment of the patient with chronic kidney disease. 5th Ed. National kidney foundation, New York,NY

Blumenkrantz MJ, Kopple JD, Gutman RA et al. Methods for assessing nutritional status of patients with renal failure. The Am J of clinical Nutritional. 1980;33: 1567-1585.

Elhafiz EM, Osman EM, Elham G anthropometric evaluation of nutritional status for patients with end stage renal disease in Sudanese patients. SJMS 2011;6: 1;89-92.

Coresh J, Astor BC. Greene T et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population. Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1-12.

Di Iorio BR, Di micco L, Marzocco S et al. Very low protein (VLPD) reduce metabolic acidosis in subjects with CKD: The ‘nutritional light signal’ of the renal acid load. Nutrients. 2017 Jan 17;9(1)

Smith E, Nieto FJ and Crespo CJ. Estimates of animal and plant Intake in US Adults: Results from the Third National Health and Nutrition Examination Survey. 1988-1991. J Am Diet Assoc 1999; 99(7):813-820.

Nath KA, H ostetter MK and Hostetter TH: Pathophysiology of chronic tubulointerstitial disease in rats: Interactions of dietary acid load, ammonia, and complement component C3. J Clin Invest. 1985;76: 667-675.

Phisitkul S, Khanna A, Simoni J et al. Amelioration of metabolic acidosis reduces urine parameters of kidney injury including tubuinterstitial injury and slows estimated GFR preservation. Kidney Int 2010; 77 (7): 617-23

Cararaca F, Arrobas M, Pizaro JL and Esparrago JF. Metabolic acidosis in advanced renal failure: differences between diabetic and non diabetic patients. Am J Kidney Dis 1999; 33:892-898.

Kleinmanyk S, Schweitzer SU, Perdue ST et al. . The use of recombinant human erythropoietin in the correction of anemia in predialytic patients and its effect on renal functions; a double blind, placebo controlled trial. Am J Kidney dis 1989; 14:486-495.

Kuriyama S, Tomonari H, Yoshida H et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in non diabetic patients. Nephron 1997; 77:176-185.

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2021-02-22

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