Hu May Khei, Witham Miles D, Soiza Roy L
NHS Grampian, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne Hospitals Trust, UK.
J Clin Med. 2019 Feb 7;8(2):208. doi: 10.3390/jcm8020208.
Metabolic acidosis is a common complication in chronic kidney disease (CKD) patients, and is associated with an accelerated decline in renal function. Oral bicarbonate therapy has been used to counteract metabolic acidosis in CKD for decades. However, until recently, there have been very few intervention studies testing the effectiveness of bicarbonate therapy at improving metabolic acidosis or its consequences in patients with CKD. In this systematic review and meta-analysis, we aimed to examine the outcomes of all published randomised controlled trials (RCTs) that investigated the effect of oral bicarbonate therapy in adults with CKD. Ovid MEDLINE, EMBASE and Cochrane Library were searched in mid-October 2018 for English literature, with no restrictions applied to the publication status or date. Seven RCTs that recruited 815 participants met our inclusion criteria after full text review. Oral bicarbonate supplementation resulted in a slightly higher estimated glomerular filtration rate (eGFR) (mean difference 3.1 mL/min per 1.73 m²; 95% CI 1.3⁻4.9) and serum bicarbonate levels (mean difference 3.4 mmol/L; 95% CI 1.9⁻4.9) at the end of follow-up (three months to five years) compared to those given placebo or conventional CKD treatment. When limited to studies reporting outcomes at one year, the positive effect of oral bicarbonate therapy on eGFR was attenuated. There were no significant treatment effects in other parameters such as systolic blood pressure (BP) and weight. These findings should be interpreted with caution and further trial evidence is needed to establish the net overall benefit or harm of oral bicarbonate therapy in CKD.
代谢性酸中毒是慢性肾脏病（CKD）患者常见的并发症，且与肾功能加速下降相关。口服碳酸氢盐治疗用于对抗CKD患者的代谢性酸中毒已有数十年。然而，直到最近，很少有干预性研究测试碳酸氢盐治疗改善CKD患者代谢性酸中毒及其后果的有效性。在这项系统评价和荟萃分析中，我们旨在研究所有已发表的随机对照试验（RCT）的结果，这些试验调查了口服碳酸氢盐治疗对成年CKD患者的影响。2018年10月中旬，我们在Ovid MEDLINE、EMBASE和Cochrane图书馆中检索了英文文献，对发表状态或日期没有限制。经过全文审查，七项招募了815名参与者的RCT符合我们的纳入标准。与给予安慰剂或传统CKD治疗的患者相比，口服补充碳酸氢盐在随访结束时（三个月至五年）导致估计肾小球滤过率（eGFR）略高（平均差异为每1.73 m² 3.1 mL/min；95%CI 1.3⁻4.9）和血清碳酸氢盐水平略高（平均差异为3.4 mmol/L；95%CI 1.9⁻4.9）。当仅限于报告一年结局的研究时，口服碳酸氢盐治疗对eGFR的积极作用减弱。在收缩压（BP）和体重等其他参数方面没有显著的治疗效果。这些发现应谨慎解读，需要进一步的试验证据来确定口服碳酸氢盐治疗在CKD中的总体净获益或危害。
