title: Oral sodium bicarbonate for the treatment of metabolic acidosis in peritoneal dialysis patients: a randomized placebo-control trial.
abstract: Acidosis causes malnutrition in peritoneal dialysis (PD) patients. The effect of oral bicarbonate in PD patients with Kt/V <2.1 has not been studied. We randomly assigned 60 PD patients with acidosis and Kt/V <2.1 to oral sodium bicarbonate (0.9 g thrice daily) or placebo. Patients were followed for 12 mo. We compared their nutritional status, including subjective global assessment (SGA) score and normalized protein nitrogen appearance (NPNA), hospitalization and all-cause mortality. Treatment with oral bicarbonate resulted in a higher plasma bicarbonate level at 4 wk (27.8 +/- 2.6 versus 24.7 +/- 3.9 mmol/L, P = 0.002), and the difference persisted until 52 wk. Bicarbonate treatment had a significant effect on the change in overall SGA score (repeated measures ANOVA, P = 0.0003). The overall SGA score of the treatment group was higher than the placebo group at 24 wk (5.07 +/- 0.94 versus 4.40 +/- 1.00, P = 0.015), and the difference persisted thereafter. NPNA rose in the treatment group (1.17 +/- 0.32 to 1.28 +/- 0.26 g/kg per d, P = 0.034), but declined in placebo group (1.13 +/- 0.25 to 1.03 +/- 0.28 g/kg per d, P = 0.054). The treatment group had a shorter hospitalization than the placebo group (8.4 +/- 17.7 versus 16.8 +/- 21.7 d/yr; P = 0.02). Mortality was not significantly different. Although our trial has limited statistical power, we find that in PD patients with mild acidosis and Kt/V <2.1, oral sodium bicarbonate probably improve nutritional status and reduce the duration of hospitalization.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. ccszeto@cuhk.edu.hk
authors.forename: Cheuk-Chun
authors.initials: CC
authors.lastname: Szeto
authors.forename: Teresa Yuk-Hwa
authors.initials: TY
authors.lastname: Wong
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Chow
authors.forename: Chi-Bon
authors.initials: CB
authors.lastname: Leung
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D000138:Acidosis / Q000188:drug therapy*; D000284:Administration, Oral; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001835:Body Weight; D003956:Dialysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000379:methods*; D010919:Placebos; D011897:Random Allocation; D006435:Renal Dialysis; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D001639:Bicarbonates; D010919:Placebos; D017693:Sodium Bicarbonate; D009584:Nitrogen