Chronic Kidney Failure and bicarbonate supplementation

The goal in caring for a patient with chronic kidney failure is to retard the progression of renal function deterioration. In a study published in the Journal of American Society of Nephrology, it was shown that daily supplementation with sodium bicarbonate was effective in slowing the progression of kidney failure. The study focused on people who are in stage 4 and 5 chronic kidney disease which is defined by their creatinine clearance. Creatinine clearance is a way to measure kidney function or glomerular filtration rate (GFR). Stage 4 is a GFR of 15 to 29 ml/min and stage 5 is <15 ml/min. Usually when people reach stage 4, they are already preparing to get dialysis. People that reach stage 5 have end stage kidney disease and dialysis is needed for life.

The study followed these patient for 2 years and noticed that patients who received the sodium bicarbonate supplementation had slower deterioration of the GFR in comparison to patients who did not receive the sodium bicarbonate supplementation (5.93 vs 1.88 ml/min.) Although the amount seems small (roughly deter 2ml/min/yr), to patient who are nearing end stage renal disease, those 2ml/min/yr could mean being put on dialysis a year or two later. This effect was also shown in the comparison of people reaching end stage renal disease (6.5 versus 33%).

Social commentary: sodium bicarbonate is the chemical name for the every day baking soda. The patients in these studies basically received baking soda compressed into a pill form. Baking soda is not patented and costs next to nothing. A jar of 1000 sodium bicarbonate pill costs 10 dollars. In comparison, a year of dialysis will costs upward of $30,000 according to American Association of Kidney patients. In 2007, Medicare spent about $8.6 billion on patients who need dialysis. If we can just push back their need for dialysis by 2 years, we essentially save 60,000 dollars off of every patient who will need dialysis assuming their lifespan stays the same. With 350,000 Americans on dialysis, we would have saved $10.5 billion on their treatment if they start dialysis one year later or $21billion if two years later. There is another study that looked at if sodium bicarbonate treatment has an effect in patients who are at earlier stages of renal disease and it does. It was also effective in retarding renal function deterioration in patients that are in stage 2 and 3 renal failure. If we start patients earlier on this treatment, we can potentially push off the need for dialysis till much much later. The quality of life for the patient is much better without dialysis. Also, the financial incentive for the failure American health system is also huge.

Of course more research is needed in order to make sodium bicarbonate a standardized therapy for patients with end stage renal disease. Currently there are multiple clinical trials underway to further substantiate the results of the study quoted earlier. If successful, it will be another tool in our arsenal in treating chronic kidney disease and our overburdened health system.