Oral bicarbonate therapy: A nutritional game-changer for hemodialysis patients?

Background: Metabolic acidosis is common in maintenance hemodialysis (MHD) patients and is associated with protein catabolism; bicarbonate supplementation could be beneficial. Aims and Objectives: The study aimed to explore the effects of oral sodium bicarbonate supplementation on nutritional parameters in MHD patients, find its optimal dosage, and side effects. Materials and Methods: A single-center, prospective, open-label, randomized, parallel-group study was conducted in Tribhuvan University Teaching Hospital, Kathmandu. A total of 58 patients on MHD with serum HCO3 <22 mEq/L were randomized with 29 patients each in the control and intervention arm. The intervention arm received oral sodium bicarbonate to maintain venous bicarbonate level >22 mEq/L along with standard care, whereas the control group received standard care alone. The mid-upper arm circumference (MUAC), mid-thigh circumference (MTC), body weight, body mass index, and serum albumin were compared between the groups at baseline and at the end of 3 months. A block randomization using computer-generated random numbers with equal allocation in two groups was used by a statistician, who was not part of the study. The sample size was determined using the standard formula for comparing two independent means, based on expected group differences and variances, with 95% confidence and 80% power. Allowing for a 10% loss to follow-up, 64 patients were enrolled. Results: Serum bicarbonate increased from 17.70±2.13 to 22.28±1.84 after treatment with oral sodium bicarbonate; the mean dose required was 2931.03±622.84 mg/day. At 3 months, the bicarbonate arm showed a significantly higher MUAC (22.37±2.03 vs. 20.0±1.94, P<0.001) and MTC (40.14±4.33 vs. 37.8±2.48, P=0.02) compared with the control. Serum albumin significantly improved in the intervention arm (40.11±2.85 vs. 36.96±3.52, P<0.001) as compared to the control. Seven (24.1%) patients receiving bicarbonate developed mild dyspepsia. Conclusion: In Nepalese patients on MHD, oral sodium bicarbonate targeting venous bicarbonate to >22 mEq/L was associated with significant improvement in clinical and biochemical markers of nutrition.