Kidney medicine · 2026
Effect of Sodium Bicarbonate on Indicators of Volume Retention in Metabolic Acidosis After Kidney Transplantation: A Post-Hoc Analysis.
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Staub Pierina S, Kronthaler David, Wiegand Anna, Dahdal Suzan, Sidler Daniel, Arampatzis Spyridon, Hadaya Karine, Seeger Harald, Wüthrich Rudolf P, Held Ulrike, Wagner Carsten A, Mohebbi Nilufar, Ritter Alexander
Аннотация
RATIONALE & OBJECTIVE: Metabolic acidosis is a frequent complication after kidney transplantation, commonly treated with sodium bicarbonate. However, concomitant sodium loading raises concerns about potential volume retention. This study aims to assess its impact on clinical and biochemical markers of volume retention, as its effects post-transplant remain insufficiently studied.
STUDY DESIGN: Post-hoc analysis of a randomized, single-blinded, placebo-controlled multicenter trial (Preserve-Transplant Study).
SETTING & PARTICIPANTS: Total of 240 kidney transplant recipients with metabolic acidosis were randomized 1:1 across 3 University hospitals in Switzerland.
INTERVENTION: 1.5-4.5 g/day sodium bicarbonate or placebo for 24 months.
OUTCOMES: Primary outcomes included body weight, N-terminal prohormone of brain natriuretic peptide, plasma renin, plasma aldosterone, aldosterone-to-renin ratio (the latter 4 log-transformed), nocturnal systolic blood pressure dipping, and antihypertensive agent use. Secondary outcomes included the occurrence of hypertension, hospitalization due to uncontrolled hypertension or volume overload, and sodium and potassium balance over time.
ANALYTICAL APPROACH: Descriptive statistics and mixed-effects regression models.
RESULTS: There was weak evidence for treatment effects in the sodium bicarbonate group compared with the placebo group regarding body weight (between-group difference [BGD]: 1.23 kg, 95% CI: -0.18 to 2.63; P = 0.09), no evidence for N-terminal prohormone of brain natriuretic peptide (BGD: -0.03, 95% CI: -0.21 to 0.16; P = 0.78), plasma renin (BGD: -0.12, 95% CI: -0.34 to 0.09; P = 0.26), and aldosterone-to-renin ratio (BGD: -0.05, 95% CI: -0.28 to 0.18; P = 0.69), whereas there was substantial evidence for a treatment effect on plasma aldosterone (BGD: -0.17, 95% CI: -0.3 to -0.05; P = 0.007), the latter 4 log-transformed. There was weak evidence for an increased chance of nocturnal systolic blood pressure dipping (OR: 2.28; 95% CI: 0.88 to 5.87; P = 0.09). The use of antihypertensives and diuretics remained similar in both groups. Weak evidence for higher serum sodium (BGD: 0.51 mEq/L, 95% CI: 0.08 to 0.94; P = 0.02) and strong evidence for higher log-transformed 24 hour-sodium excretion (BGD: 0.16, 95% CI: 0.07 to 0.26; P ≤ 0.001) in the sodium bicarbonate group were identified. There was no or weak evidence for treatment effects on other secondary outcomes. Subgroup analyses showed no major differential effects.
LIMITATIONS: Post-hoc analysis, mainly Caucasian study population.
CONCLUSIONS: Our findings did not provide clear evidence for unfavorable effects of sodium bicarbonate on volume retention. Further research is required to clarify risks.
TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT03102996).
STUDY DESIGN: Post-hoc analysis of a randomized, single-blinded, placebo-controlled multicenter trial (Preserve-Transplant Study).
SETTING & PARTICIPANTS: Total of 240 kidney transplant recipients with metabolic acidosis were randomized 1:1 across 3 University hospitals in Switzerland.
INTERVENTION: 1.5-4.5 g/day sodium bicarbonate or placebo for 24 months.
OUTCOMES: Primary outcomes included body weight, N-terminal prohormone of brain natriuretic peptide, plasma renin, plasma aldosterone, aldosterone-to-renin ratio (the latter 4 log-transformed), nocturnal systolic blood pressure dipping, and antihypertensive agent use. Secondary outcomes included the occurrence of hypertension, hospitalization due to uncontrolled hypertension or volume overload, and sodium and potassium balance over time.
ANALYTICAL APPROACH: Descriptive statistics and mixed-effects regression models.
RESULTS: There was weak evidence for treatment effects in the sodium bicarbonate group compared with the placebo group regarding body weight (between-group difference [BGD]: 1.23 kg, 95% CI: -0.18 to 2.63; P = 0.09), no evidence for N-terminal prohormone of brain natriuretic peptide (BGD: -0.03, 95% CI: -0.21 to 0.16; P = 0.78), plasma renin (BGD: -0.12, 95% CI: -0.34 to 0.09; P = 0.26), and aldosterone-to-renin ratio (BGD: -0.05, 95% CI: -0.28 to 0.18; P = 0.69), whereas there was substantial evidence for a treatment effect on plasma aldosterone (BGD: -0.17, 95% CI: -0.3 to -0.05; P = 0.007), the latter 4 log-transformed. There was weak evidence for an increased chance of nocturnal systolic blood pressure dipping (OR: 2.28; 95% CI: 0.88 to 5.87; P = 0.09). The use of antihypertensives and diuretics remained similar in both groups. Weak evidence for higher serum sodium (BGD: 0.51 mEq/L, 95% CI: 0.08 to 0.94; P = 0.02) and strong evidence for higher log-transformed 24 hour-sodium excretion (BGD: 0.16, 95% CI: 0.07 to 0.26; P ≤ 0.001) in the sodium bicarbonate group were identified. There was no or weak evidence for treatment effects on other secondary outcomes. Subgroup analyses showed no major differential effects.
LIMITATIONS: Post-hoc analysis, mainly Caucasian study population.
CONCLUSIONS: Our findings did not provide clear evidence for unfavorable effects of sodium bicarbonate on volume retention. Further research is required to clarify risks.
TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT03102996).