Nutritional supplementation to prevent and slow the progression of chronic kidney disease: focus on bicarbonate
Vahan Koshkaryan1, Albert Yuh-Jer Shen2, Roxana Mehran3, Prakash Mansukhani4, Somjot S Brar4,5
1Department of Internal Medicine, 2Division of Cardiology, Kaiser Permanente, Los Angeles, CA, USA; 3Columbia University Medical Center, New York, NY, USA; 4Regional Cardiac Catheterization Laboratory, Kaiser Permanente, Los Angeles, CA, USA; 5Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
Abstract: Sodium bicarbonate is an important buffer in the maintenance of acid/base homeostasis. It plays an important role in preventing acidemia and associated complications. Among patients with chronic kidney disease, metabolic acidosis has been linked to disorders of muscle and bone metabolism. Administration of sodium bicarbonate can largely correct these abnormalities. More recently, the use of sodium bicarbonate for the prevention of contrastmedium induced nephropathy has generated considerable interest. Contrast induced nephropathy is a common complication of iodinated contrast media exposure in patient with chronic kidney disease. There are now multiple randomized controlled trials comparing sodium bicarbonate to sodium chloride among patients with chronic kidney disease. However, the results of these trials are not conclusive on the efficacy of sodium bicarbonate hydration for the prevention of contrast nephropathy. In this review, we discuss the role of sodium bicarbonate treatment in chronic kidney disease with an emphasis on prevention of contrast induced nephropathy. Insights gained from randomized trials and meta-analyses are discussed.
Keywords: sodium bicarbonate, chronic kidney disease, contrast induced nephropathy
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