Alkali Therapy for Kidney Complication

Overseen By Jessica Kendrick, MD MPH

Age: 18+

Sex: Any

Trial Phase: Phase 4

Sponsor: University of Colorado, Denver

Must be taking: Immunosuppressants

Must not be taking: Anticoagulants, Alkali therapy

Disqualifiers: Heart failure, Uncontrolled hypertension, others

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

120 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether sodium bicarbonate (baking soda) can improve kidney and heart health in individuals who have undergone a kidney transplant. Researchers aim to determine if this treatment can address issues like graft loss and heart problems by reducing acid levels in the body. Participants must have received a kidney transplant at least a year ago and currently maintain stable blood pressure and medical treatments. As a Phase 4 trial, this research seeks to understand how the already FDA-approved and effective treatment benefits a broader range of patients.

Do I need to stop my current medications for the trial?

The trial does not specify if you need to stop your current medications, but you must have a stable immunosuppression and anti-hypertensive regimen before joining. You cannot take medications that interact with the trial's agents, like sildenafil with nitroglycerin.

What is the safety track record for sodium bicarbonate?

Research shows that baking soda (sodium bicarbonate) can benefit kidney health. Studies have found that it may slow the progression of kidney function decline in people with chronic kidney disease (CKD), potentially helping kidneys work better over time.

Patients treated with baking soda for metabolic acidosis (a condition with excess acid in the body) often experience improvements in kidney function. This suggests that baking soda might help maintain kidney health longer.

However, some risks exist. Baking soda can sometimes cause issues like milk-alkali syndrome (a condition with excess calcium in the blood) and can raise sodium levels in the blood. These side effects are important to consider when thinking about joining a trial.

Overall, many patients tolerate baking soda well, but discussing any concerns with health professionals before joining a clinical trial is always best. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Unlike the standard treatments for kidney complications, which often focus on controlling symptoms and managing blood pressure, sodium bicarbonate works by neutralizing acid in the blood. This alkalizing effect can help slow the progression of kidney damage, potentially offering a new angle for treatment. Researchers are excited about sodium bicarbonate because it targets the body's acid-base balance, which is crucial in preventing further kidney damage, making it a promising addition to current therapeutic strategies.

What evidence suggests that sodium bicarbonate might be an effective treatment for kidney complications?

Research has shown that sodium bicarbonate, which participants in this trial may receive, might help improve kidney function in people with chronic kidney disease (CKD). It can slow the decline of kidney function, as indicated by improved eGFR (a measure of how well the kidneys filter blood) and creatinine levels. Some studies have also found that it aids in sodium excretion, potentially benefiting kidney health. However, not all studies agree on its benefits; some suggest it might not enhance physical health or could cause more side effects. Overall, sodium bicarbonate may support kidney function, but results can vary. Participants in this trial may also receive a placebo, serving as a control to evaluate the effectiveness of sodium bicarbonate. ^{1 2 6 7 8}

Who Is on the Research Team?

Jessica Kendrick, MD MPH

Principal Investigator

University of Colorado Denver | Anschutz

Are You a Good Fit for This Trial?

This trial is for kidney transplant recipients aged 18-80 with stable health, not on conflicting meds or treatments, and a BMI under 40. They should have had their transplant at least a year ago, be on specific immunosuppressants, and have certain levels of serum bicarbonate and eGFR—a measure of kidney function.

Inclusion Criteria

Your body mass index (BMI) is less than 40 kg/m2.

Your blood test results show a normal level of bicarbonate on two different days.

Your kidney function, measured by eGFR, needs to be at least 45 ml/min/1.73m2.

Exclusion Criteria

I regularly use supplemental oxygen.

I have not taken daily oral alkali like baking soda in the last 3 months.

I am currently taking blood thinners.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive sodium bicarbonate or placebo for 12 months to assess effects on vascular and graft function

12 months

Regular visits for monitoring and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Placebo
• Sodium bicarbonate

Trial Overview The study tests if sodium bicarbonate can improve heart and graft health in those who've received a kidney transplant. It's a double-blind study where half the participants will get sodium bicarbonate and the other half a placebo for one year to compare effects.

How Is the Trial Designed?

Group I: Sodium bicarbonate Experimental Treatment 1 Intervention

Oral sodium bicarbonate at a dose of 0.5 mEq/kg-lean body weight/day

Group II: Placebo Placebo Group 1 Intervention

Oral placebo at a dose of 0.5 mEq/kg-lean body weight/day

Sodium bicarbonate is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Sodium bicarbonate for:

• Metabolic acidosis
• Antacid
• Heartburn relief

Approved in European Union as Sodium bicarbonate for:

• Metabolic acidosis
• Antacid

Approved in Canada as Sodium bicarbonate for:

• Metabolic acidosis
• Antacid

Who Is Running the Clinical Trial?

University of Colorado, Denver

Lead Sponsor

Trials

1,842

Recruited

3,028,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Published Research Related to This Trial

Long-term sodium bicarbonate therapy can slightly slow down the loss of kidney function in patients with chronic kidney disease (CKD) and may help reduce the risk of progressing to end-stage renal disease, based on meta-analyses of lower-quality randomized controlled trials.

However, therapy lasting 1 year or less may not provide any benefits, indicating that longer treatment durations are necessary for potential effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is bicarbonate therapy effective in preventing CKD progression? Ahmad, H., Wertin, T., Zhang, Y., et al.[2022]

Sodium bicarbonate significantly reduces the risk of contrast-induced nephropathy (CIN) in patients with pre-existing renal insufficiency, as shown in a meta-analysis of 20 randomized controlled trials involving 4280 participants.

While sodium bicarbonate is effective in preventing CIN, it does not lower the risks of dialysis or mortality, indicating that it does not improve overall clinical outcomes for patients affected by CIN.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis. Zhang, B., Liang, L., Chen, W., et al.[2019]

There is currently no randomized controlled trial evidence supporting the use of sodium bicarbonate for treating acute kidney injury (AKI), despite its common recommendation due to associated acidosis.

The review highlights an urgent need for well-conducted randomized controlled trials to evaluate the efficacy and safety of sodium bicarbonate in patients with AKI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sodium bicarbonate supplements for treating acute kidney injury. Hewitt, J., Uniacke, M., Hansi, NK., et al.[2023]

Rats that were pretreated with sodium bicarbonate showed significant protection against kidney damage from renal artery occlusion, with lower serum creatinine levels compared to control rats, indicating its efficacy in preventing acute renal failure.

The protective effect of sodium bicarbonate does not appear to be due to systemic alkalosis or sodium loading, as similar results were observed with acetazolamide, suggesting a unique mechanism of action for bicarbonate in renal protection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of sodium bicarbonate preloading on ischemic renal failure. Atkins, JL.[2022]

In a multicenter pilot trial involving 194 adults with chronic kidney disease (CKD), both higher-dose (0.8 meq/kg) and lower-dose (0.5 meq/kg) oral sodium bicarbonate (NaHCO3) were well tolerated over 28 weeks, showing no significant differences in adverse events or hospitalizations compared to placebo.

The higher dose of NaHCO3 resulted in a greater increase in serum bicarbonate levels and a reduction in urinary ammonium excretion, but it also led to a larger increase in urinary albumin/creatinine ratio (ACR), suggesting that while it may be effective, careful monitoring of kidney function is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Raphael, KL., Isakova, T., Ix, JH., et al.[2021]

In a study of 108 patients with stage 3 chronic kidney disease (CKD), dietary alkali treatment using sodium bicarbonate or base-producing fruits and vegetables helped preserve kidney function (eGFR) over 3 years compared to usual care.

The treatment not only increased plasma total CO2 levels but also reduced kidney angiotensin II activity, suggesting that even mild metabolic acidosis can be managed effectively to protect kidney health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Goraya, N., Simoni, J., Jo, CH., et al.[2022]

In a study involving 34 healthy volunteers, potassium sodium hydrogen citrate (PSHC) was found to significantly increase urine pH levels compared to sodium bicarbonate (NaHCO3), indicating that PSHC is more effective for urinary alkalization.

The study also revealed a natural circadian rhythm in urine pH, with both PSHC and NaHCO3 elevating urine pH levels without disrupting this rhythm, suggesting that PSHC can be used effectively without adverse effects on the body's natural processes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison potassium sodium hydrogen citrate with sodium bicarbonate in urine alkalization: a prospective crossover-controlled trial. Xue, W., Cheng, J., Zhao, J., et al.[2023]

Sodium bicarbonate is generally safe for oral use, with no documented toxicity in emergency medicine literature, but excessive intake can lead to serious health risks such as metabolic alkalosis and hypernatremia.

A case study highlighted the potential dangers of chronic excessive bicarbonate ingestion, showing that it can lead to multiple hospital admissions due to complications like hyperkalemia and disruption of calcium and phosphorus metabolism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute toxicity from baking soda ingestion. Thomas, SH., Stone, CK.[2019]

A systematic review of 6 randomized controlled trials involving 312 patients found that sodium bicarbonate therapy significantly improved kidney function in patients with chronic kidney disease (CKD), leading to a decrease in serum creatinine and an increase in glomerular filtration rate (GFR).

Long-term alkali therapy was associated with a lower risk of needing dialysis, indicating potential benefits in slowing CKD progression, while no adverse effects on blood pressure medication were noted.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review. Susantitaphong, P., Sewaralthahab, K., Balk, EM., et al.[2021]

Oral sodium bicarbonate significantly increases serum bicarbonate levels and slows the decline in kidney function (eGFR) in patients with chronic kidney disease (CKD), based on a systematic review of 1853 patients.

The treatment also leads to a notable reduction in systolic and diastolic blood pressure, suggesting potential cardiovascular benefits, while showing no significant adverse effects on body weight or muscle mass.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Cheng, F., Li, Q., Wang, J., et al.[2023]

A patient who ingested over 50 grams of sodium bicarbonate daily for 40 years developed severe health issues, including metabolic alkalosis, epileptic convulsions, and end-stage renal failure requiring hemodialysis.

Kidney biopsy revealed significant damage, including mesangial proliferative glomerulonephritis and arterial wall thickening, indicating that long-term sodium bicarbonate use can lead to serious renal complications and chronic kidney disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Forty years abuse of baking soda, rhabdomyolysis, glomerulonephritis, hypertension leading to renal failure: a case report. Forslund, T., Koistinen, A., Anttinen, J., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8665881/

The Effects of Oral Sodium Bicarbonate on Renal Function ... In addition, the results showed significantly increased urinary sodium excretion in patients with CKD after oral sodium bicarbonate therapy.

2. journals.lww.com journals.lww.com/cjasn/fulltext/2024/08000/sodium_bicarbonate_treatment_and_clinical_outcomes.7.aspx

Sodium Bicarbonate Treatment and Clinical Outcomes in... Sodium bicarbonate for patients with CKD and metabolic acidosis leads to a significant improvement in kidney function. Treatment with sodium bicarbonate ...

3. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK558299/

Clinical effectiveness results - Sodium bicarbonate ... Clinical effectiveness results - Sodium bicarbonate to improve physical function in patients over 60 years with advanced chronic kidney disease: the BiCARB RCT.

4. sciencedirect.com sciencedirect.com/science/article/pii/S2468024920318520

A Systematic Review and Meta-Analysis on Effects of ... Compared with placebo or no study medication, oral sodium bicarbonate treatment attenuated decline in kidney function, as assessed by eGFR or creatinine ...

5. bmcmedicine.biomedcentral.com bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01542-9

Clinical and cost-effectiveness of oral sodium bicarbonate ... Oral sodium bicarbonate did not improve physical function or renal function, increased adverse events and is unlikely to be cost-effective for use by the UK ...

6. kidney.org kidney.org/kidney-failure-risk-factor-serum-bicarbonate

Kidney Failure Risk Factor: Serum Bicarbonate Studies on thousands of patients with a low serum bicarbonate showed that they reached kidney failure faster than patients with a normal serum bicarbonate. The ...

7. webmd.com webmd.com/vitamins/ai/ingredientmono-1470/sodium-bicarbonate

Sodium Bicarbonate - Uses, Side Effects, And More Taking sodium bicarbonate might increase the risk of complications such as milk-alkali syndrome. High sodium levels in the blood: Sodium bicarbonate might ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S0085253815562340

Bicarbonate therapy for prevention of chronic kidney ... This review focuses on the potential that orally administered NaHCO3 prevents CKD progression and additionally addresses its mechanism of action, side effects, ...