Division of Nephrology, Kidney and Dialysis Research Laboratory, Department of Medicine, St. Elizabeth's Medical Center, Boston, MA 02135, USA.
Am J Nephrol. 2012;35(6):540-7. doi: 10.1159/000339329. Epub 2012 May 29.
Clinical practice guidelines recommend alkali therapy in patients with non-dialysis-dependent chronic kidney disease (CKD) and metabolic acidosis to prevent complications from metabolic acidosis. We systematically reviewed the effect of sodium bicarbonate on benefits and harms in patients with CKD.
We searched for randomized controlled trials in MEDLINE (through July 2011), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and scientific abstracts. We included trials that compared sodium bicarbonate to standard-of-care therapy or placebo that reported on kidney-related outcomes. We performed random-effects model meta-analyses to compute net changes (for continuous variables) and risk ratios (for binary variables).
Two short-term (≤ 7 days) crossover trials and 4 long-term (≥ 2 months) parallel-design randomized controlled trials met eligibility (312 patients). All 6 trials prescribed sodium bicarbonate in the alkali-treated group. In the long-term studies, alkali therapy was associated with a net decrease in serum creatinine (-0.07 mg/dl, 95% CI -0.09, -0.05; p < 0.001; I(2) = 0), a net improvement in GFR (3.2 ml/min/1.73 m(2), 95% CI 1.6, 4.7; p < 0.001; I(2) = 0), and a lower incidence of dialysis initiation (risk ratio 0.21, 95% CI 0.08, 0.54; p = 0.001; I(2) = 0). No benefit was observed on the serum creatinine or GFR in short-term studies. Alkali therapy was not associated with a higher likelihood of initiating or escalating anti-hypertensive medications.
Alkali therapy is associated with an improvement in kidney function, which may afford a long-term benefit in slowing the progression of CKD. However, differences in study protocols and small sample sizes preclude definitive conclusions.
临床实践指南建议非透析依赖型慢性肾脏病（CKD）伴代谢性酸中毒的患者采用碱化疗法，以预防代谢性酸中毒引起的并发症。我们系统地回顾了碳酸氢钠对 CKD 患者的获益和危害的影响。
我们在 MEDLINE（截至 2011 年 7 月）、Cochrane 对照试验中心注册库、ClinicalTrials.gov 和科学摘要中搜索了随机对照试验。我们纳入了比较碳酸氢钠与标准治疗或安慰剂、并报告了肾脏相关结局的试验。我们采用随机效应模型进行荟萃分析，以计算净变化（连续变量）和风险比（二分类变量）。
两项短期（≤7 天）交叉试验和 4 项长期（≥2 个月）平行设计的随机对照试验符合入选标准（共 312 例患者）。所有 6 项试验均在碱化治疗组中应用了碳酸氢钠。在长期研究中，碱化治疗与血清肌酐的净下降相关（-0.07mg/dl，95%CI-0.09，-0.05；p<0.001；I²=0），肾小球滤过率（GFR）的净改善相关（3.2ml/min/1.73m²，95%CI1.6，4.7；p<0.001；I²=0），以及启动透析的发生率降低相关（风险比 0.21，95%CI0.08，0.54；p=0.001；I²=0）。短期研究中未观察到血清肌酐或 GFR 的获益。碱化治疗与启动或升级抗高血压药物的可能性增加无关。
碱化治疗与肾功能的改善相关，这可能为减缓 CKD 的进展带来长期获益。然而，由于研究方案的差异和样本量小，无法得出明确的结论。
