Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status
Kendall R. Murray
Golden West College School of Nursing
Abstract
Throughout a nurses lifetime he or she will come across countless patients who have some sort of kidney damage. Kidney damage can be acute, due to hypovolemia for instance, or chronic. Chronic kidney disease occurs when the kidneys are damage and cannot filter blood properly. This damage causes an excess buildup of waste and fluid to remain circulating in the body. 30 million people nationwide are effected by Chronic kidney disease (CKD). Hundreds of thousands of people with kidney damage or reduced kidney function are not aware they have an issue. Since CKD is such a prevalent diagnosis in our society, it is important to address some ways to best manage patients with CKD. Along with medical management of hypertension, diabetes, and dialysis, doctors are prescribing sodium bicarbonate. Sodium Bicarbonate works as a buffer. It is a prescribes as a supplement for patients with chronic kidney disease who are in metabolic acidosis. Metabolic acidosis is characterized by low plasma bicarbonate and is extremely common is patients with chronic kidney disease. Nurses give sodium bicarbonate almost every day, but how well does it actually work? It is important for nurses and nursing students to be experts on the medications they give and be able to identify why the patients are prescribed these medications. This paper will assess if in fact sodium bicarbonate is slowing the progression of chronic kidney disease and if there are any other areas it is affecting as well.
Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status
Method
Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status compares the effects of oral sodium bicarbonate supplementation and standard care on the progression of CKD in predialysis patients. The participants in the study were patients of the low-clearance clinical at Royal London Hospital. 184 patients with CKD and low bicarbonate levels were considered. Of that 184, only 134 were recruited. 20 patients refused to sign consent and another 30 patients were ineligible. Patients were considered ineligible if they were on steroid therapy, had heart failure, uncontrolled hypertension, cognitive impairments, ongoing sepsis, or were morbidly obese. Prior to becoming a part of this study, the patients were asked to take part in a 24 hour urine collection After the recruitment, 5 patients withdrew from the treatment group. 3 patients had transferred to another renal clinical and 2 patients refused to complete the 24 hour urine collection process every 2 months. From the patients who completed the urine collection only the patients who fell into the creatinine clearance values of 30-15 ml/min range were picked to continue.
The study conducted a single,-center, open-label, randomized, prospective, parallel-group study over 3 years with a 2 year follow up period. This study randomly assigned the 134 patients with chronic kidney disease and serum bicarbonate levels 16-20 mmol/L to one of two groups: Oral supplementation with sodium bicarbonate or standard of care for 2 years. The overall demographic characteristics of both groups were similar. The oral supplementation group received 600 mg of sodium bicarbonate 3 times daily. The does was increased as necessary to maintain bicarbonate levels of >23 mmol/L. The treatment group or control group received routine standard care. Apart from the oral sodium bicarbonate given to one group, the patients in both groups received the same treatment and monitoring for their CKD. In the oral supplementation group, the sodium bicarbonate is the independent variable and the creatinine clearance levels are considered the dependent variable.
Results
At the 12 month mark, data was gathered and assessed. 17 patients from the control group has dropped out of the study because they had reached ESDR within 6 months. In the control group there was an observed increase in creatinine clearance by 5.93 ml/min compared to the 1.88ml/min in the supplement group. 9 patients from the supplemental group progressed further in there CKD diagnosis where as 45% of the control group progressed. 22 patients in the control group developed ESDR that required dialysis. Kaplan-Mierer analysis showed the control group had a higher probability of starting dialysis than the supplemental group. Overall this study showed that taking oral sodium bicarbonate is associated with a slowing of the rate of decline in renal function per year in patients with chronic kidney disease. Throughout this study it was found that sodium bicarbonate had no adverse effects on blood pressure or edema.
Limitations
Although the 134 sample size is a substantial size, there are a few limitations on this group. If a patient who has co-morbidities that fall under use of steroids, heart failure, uncontrolled hypertension, cognitive impairments, ongoing sepsis, or were morbidly obese they were excluded from the study. Many patients who have these co-morbidities are the patients who are seen by healthcare providers for chronic kidney disease. The study also did not specify which age, genders, or ethnic backgrounds that patient population were. Depending on the patient population chosen, the study could have different results.
Future Nursing Practice
As mentioned above, hundreds of thousands of patients walk thorough hospital and clinical doors each day who are effected by chronic kidney disease. Throughout a nurses career he or she will provide care for many of these patients. It is important for nurses to understand why they are giving each patient the medications they are and how they are affecting their overall condition. Throughout reading this article it is apparent that oral sodium bicarbonate is extremely beneficial in slowing the process of CKD to ESDR. The sodium bicarbonate pills are substantial in size. Many patients complain about the size of the medication as well as the salty taste that sometimes remains in there mouth afterward. It is imperative that nurses educate patients on the extreme importance of this medication. Teaching the patient that although this pill is an inconvenience and can cause some temporary discomfort, it will benefit there health in the long run. 3 large salty pills daily could save them from having to sit though hours of dialysis multiple times a week.
References
De Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status. Journal of the American Society of Nephrology : JASN, 20(9), 2075–2084. http://doi.org/10.1681/ASN.2008111205