Sodium bicarbonate supplements for treating acute kidney injury: Cochrane systematic review

Abstract

Assessed as up to date: 2017/05/12

Background

Acute kidney injury (AKI) is a common, serious, but potentially treatable condition. Because AKI is often associated with acidosis, it has become common practice to recommend administration of sodium bicarbonate to correct acid imbalance.

Objectives

To assess the benefits and harms of the use of sodium bicarbonate for people with AKI. The primary outcome measure was all-cause mortality, and secondary outcome measures were patients' need for renal replacement therapy; return to baseline kidney function; and overall survival.

Search methods

We searched the Cochrane Kidney and Transplant Specialised Register up to 12 May 2017 through contact with the Information Specialist using search terms relevant to this review.

Selection criteria

All randomised controlled trials (RCTs) that investigated the use of sodium bicarbonate supplements, administered by any route, for the treatment of adults with AKI were to be included. The search strategy did not restrict inclusion based on an upper age limit or publication language. We did not consider inclusion of studies that investigated use of sodium bicarbonate for AKI prevention.

Data collection and analysis

All authors planned to independently assess and extracted information. Information was to be collected on methods, participants, interventions and outcomes. Results were to be expressed as risk ratios (RR) for dichotomous outcomes or as mean differences (MD) for continuous data with 95% confidence intervals (CI).

Main results

Although our literature search identified four studies, none of these met our predetermined selection criteria. Hence, no suitable studies were identified for inclusion in this review.

Authors' conclusions

We found no RCT evidence - supportive or otherwise - for the use of sodium bicarbonate for people with AKI. We concluded that there is an urgent need for well conducted RCTs in this area.

Author(s)

Hewitt Jonathan, Uniacke Mark, Hansi Navjyot K, Venkat-Raman Gopalakrishnan, McCarthy Kathryn

Summary

Is sodium bicarbonate therapy helpful for people with acute kidney problems?

Acute kidney damage is a common problem that is often found in people who need treatment for problems not related to kidney health. Failing kidney health often causes more acid than normal in the blood (acidosis), which in itself is thought to cause harm.

It has been suggested that a treatment strategy for patients with acidosis is to give alkaline solutions to counteract or neutralise effects of the acid. Sodium bicarbonate is the alkaline solution normally used.

We searched the medical literature for evidence about the benefits or harms of giving sodium bicarbonate to people whose kidneys are failing. We did not find any randomised controlled trials (RCTs) that assessed the benefits or harms of giving sodium bicarbonate to people with acute kidney problems.

Therefore, we cannot recommend or dismiss the use of sodium bicarbonate for people with kidney problems. We recommend that RCTs are conducted to answer this question.

Reviewer's Conclusions

Implications for practice

An absence of relevant studies meant that results from this review could not recommend or refute the use of sodium bicarbonate for the treatment of patients with AKI. As a matter of course, treatment regimens; doses; or routes of administration could not be identified, supported, or refuted.

Implications for research

Large scale, well-conducted RCTs are required to inform assessment of benefits, treatment regimens, or potential harms associated with use of sodium bicarbonate for people with AKI.

Sodium bicarbonate is currently used in the management of AKI, and therefore, equipoise exists. To facilitate future investigation, we recommend that consideration be given to conducting large scale, well-conducted observational studies to inform planning before undertaking RCTs.

In the authors opinion there is clinical equipoise regarding the benefit or harms of administration of sodium bicarbonate therapy, as such adequately powered and well-designed studies are needed to address this issue. Such as study should include adults of all ages with AKI, to reflect our aging society. The intervention should be sodium bicarbonate compared to placebo and outcomes should include mortality, the long term use of dialysis, and length of hospital stay.

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