Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy

Ashutosh Mahajan, Jan Simoni, Simon J. Sheather, Kristine R. Broglio, M. H. Rajab, Donald E. Wesson

Research output: Contribution to journalArticlepeer-review

314 Scopus citations

Abstract

In most patients with hypertensive nephropathy and low glomerular filtration rate (GFR), the kidney function progressively declines despite the adequate control of the hypertension with angiotensin-converting enzyme inhibition. Previously we found that 2 years of oral sodium citrate slowed GFR decline in patients whose estimated GFR (eGFR) was very low (mean 33 ml/min). This treatment also slowed GFR decline in an animal model of surgically reduced nephron mass. Here, we tested if daily oral sodium bicarbonate slowed GFR decline in patients with hypertensive nephropathy with reduced but relatively preserved eGFR (mean 75 ml/min) in a 5-year, prospective, randomized, placebo-controlled, and blinded interventional study. Patients matched for age, ethnicity, albuminuria, and eGFR received daily placebo or equimolar sodium chloride or bicarbonate while maintaining antihypertensive regimens (including angiotensin-converting enzyme inhibition) aiming for their recommended blood pressure targets. After 5 years, the rate of eGFR decline, estimated using plasma cystatin C, was slower and eGFR was higher in patients given sodium bicarbonate than in those given placebo or sodium chloride. Thus, our study shows that in hypertensive nephropathy, daily sodium bicarbonate is an effective kidney protective adjunct to blood pressure control along with angiotensin-converting enzyme inhibition.

Original languageEnglish
Pages (from-to)303-309
Number of pages7
JournalKidney International
Volume78
Issue number3
DOIs
StatePublished - Aug 2010

Bibliographical note

Funding Information:
We are thankful to the nursing and clerical staff of the Internal Medicine Clinic of the Department of Internal Medicine at Texas Tech University Health Sciences Center for their assistance and to the Inside Out Community Outreach Program of Lubbock, Texas for making these studies possible. This work was supported by funds from the Larry and Jane Woirhaye Memorial Endowment in Renal Research, the Texas Tech University Health Sciences Center, by the Statistics Department of Texas A&M University, and by the Research Division of Scott and White Healthcare.

Keywords

  • acidosis
  • albuminuria
  • chronic kidney disease
  • chronic metabolic acidosis
  • hypertension

ASJC Scopus subject areas

  • Nephrology

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