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.

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.

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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 strategy: 

In November 2011 we searched the Cochrane Renal Group’s Specialised Register using keywords relevant to this review. The register is populated using searches of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and handsearching records from renal-related journals and conference proceedings.

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.

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