AUTHOR=Cheng Ya-Lien , Huang Shu-Chun , Ho Ming-Yun , Li Yan-Rong , Yen Chieh-Li , Chen Kuan-Hsing , Sun Wei-Chiao , Fan Pei-Yi , Chen Jung-Sheng , Lin Chihung , Hsiao Ching-Chung 

TITLE=Effect of sodium bicarbonate on cardiovascular outcome and mortality in patients with advanced chronic kidney disease

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1146668

DOI=10.3389/fphar.2023.1146668

ISSN=1663-9812

ABSTRACT=Background: Metabolic acidosis is common in patients with chronic kidney disease 
(CKD). Oral sodium bicarbonate is commonly used to treat metabolic acidosis and 
prevent the progression of CKD. 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: The cohort study was conducted using data from the Chang Gung Research 
Database, a multi-institutional electronic medical record database in Taiwan. A cohort 
of 25599 patients with CKD stage V were identified between January 1, 2001 to 
December 31, 2019. The exposure was defined as receiving sodium bicarbonate or 
not. The primary outcomes were dialysis initiation, major adverse cardiovascular 
events (MACE) (myocardial infarction, heart failure, stroke), and all-cause mortality.   
Stabilized inverse probability of treatment weighting was used to balance baseline 
covariates. We compared risks of dialysis, MACE and mortality between groups using 
Cox proportional hazards models. In addition, we conducted an analysis using Fine 
and Gray sub-distribution hazard model that considered death as 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 (HR, 0.98; 95% 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: The cohort study found that in real world practice, among patients with 
advanced CKD stage V, use of sodium bicarbonate was associated with similar risk of 
dialysis compared with non-users, Nonetheless, use of sodium bicarbonate was 
associated with significantly lower rate of MACE and mortality. The study results 
reinforced the benefits of sodium bicarbonate therapy in the expanding CKD 
population. Further prospective studies are needed to confirm these findings.