Table of Contents
Introduction
Several chronic medical conditions cause morbidity and mortality in the population, and such diseases are also a part of global health concerns as they affect the productivity of a society collectively. So, measures are always taken to target morbidity-causing diseases and improve societal health and prosperity. One such cause of concern for global health is the incidence of chronic kidney disease. Various treatment modalities targeting the pathogenesis are being developed. Sodium bicarbonate usage for kidney disease management is also for such a purpose.
What Is Sodium Bicarbonate?
Sodium bicarbonate, with the chemical name NaHCO₃, is a highly effective alkaline agent with a pH of nine. When ingested, it dissolves into sodium (Na⁺) and bicarbonate (HCO₃⁻) ions. This property of sodium bicarbonate is utilized to treat metabolic acidosis in the body that occurs in individuals with chronic kidney disease.
What Is Metabolic Acidosis?
Chronic kidney disease can cause metabolic acidosis as a complication. In this condition, excessive amounts of acid in the body cannot be neutralized. This inability to neutralize arises due to kidney dysfunction and the diminished ability to excrete hydrogen ions and reabsorb bicarbonate. The imbalance in the acid and base proportions in the body occurs because damaged kidneys cannot meet up and maintain the acid-base homeostasis within the body. When this chronic kidney disease is prolonged, the levels of acids start to pile up. The main acids noted are phosphoric and sulfuric acids derived from protein in the diet. This causes a profound drop in the pH levels in the blood as well. This acidic environment can cause significant physiological disturbances, including bone demineralization, as the body leaches calcium from bones to buffer the acid, muscle wasting due to increased protein catabolism, and systemic inflammation, further impaired renal function. Since metabolic acidosis is such a life-threatening condition, treating it immediately becomes an essential part of management. Sodium bicarbonate serves this purpose.
How Is Sodium Bicarbonate Helpful in Managing Kidney Disease?
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The bicarbonate ion produced in the process of splitting sodium bicarbonate (after ingestion) acts as a perfect buffer agent for neutralizing the excess acid levels in the body. Hence, this method treats metabolic acidosis associated with kidney disease. Sodium bicarbonate achieves this by reacting with hydrogen ions of the acid, thereby increasing the pH of the blood to normal. As a result, the body's acid-base balance will be restored.
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Recent research has suggested that using sodium bicarbonate can slow the progression of chronic kidney disease. By reducing metabolic acidosis, sodium bicarbonate lessens the strain on the kidneys, potentially delaying the decline in renal function.
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One major side effect of metabolic acidosis in the body is leaching out calcium ions from healthy bones (bone demineralization) to combat the excess acidic levels in the body. Prescribing sodium bicarbonate in such cases helps prevent bone demineralization and preserve the integrity of the bones.
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Muscle breakdown manifesting as muscle weakness and wastage is another side effect of metabolic acidosis. By treating metabolic acidosis, sodium bicarbonate helps to inhibit the catabolism process that occurs in the muscles. This will improve muscular strength while preserving the structure.
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Exacerbation of chronic kidney disease also coincides with the incidence of metabolic acidosis. This is because metabolic acidosis activates the inflammatory cytokines and the resultant inflammatory pathway in the body. Calcification of the vascular system (blood vessel walls) can cause cardiovascular morbidities secondary to chronic kidney disease and metabolic acidosis. Thus, by addressing metabolic acidosis, sodium bicarbonate aims to eliminate the possibility of cardiovascular complications completely.
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Studies have also suggested correcting metabolic acidosis with sodium bicarbonate can lower mortality rates.
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Maintaining proper electrolyte balance is a serious step in chronic kidney disease. Sodium bicarbonate supplementation helps manage this balance by compensating for the kidneys' reduced bicarbonate reabsorption capabilities stabilizing electrolyte levels within the circulation and body.
Sodium bicarbonate can be given as an oral supplement, where powder is mixed with water before consumption. It is also available for treating kidney disease through intravenous or intramuscular routes.
What Are the Adverse Effects of Using Sodium Bicarbonate for Kidney Disease?
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The sodium component in the sodium bicarbonate supplementation also increases in the blood. This leads to hypernatremia.
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Increased sodium concentration in the circulating blood will also exacerbate the existing hypertensive condition in chronic kidney disease patients. In such cases, managing hypertension secondary to sodium bicarbonate intake becomes extremely challenging.
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Fluid retention will be exacerbated after ingestion of sodium bicarbonate. This leads to swelling of the limbs. This occurs commonly among people with heart failure or people under dialysis procedures.
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Overcorrection of the metabolic acidosis condition can lead to the incidence of metabolic alkalosis (the alkaline nature of blood increases). This will cause cramps in the muscles, confusion, tremors in the hands, and fatigue.
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The most frequent issue reported by people taking sodium bicarbonate is bloating. This gastrointestinal discomfort is due to the chemical reaction between bicarbonate ions and stomach acid. This reaction causes carbon dioxide, which causes a sense of fullness. Nausea is also reported after sodium bicarbonate intake.
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Therapy with sodium bicarbonate can cause excessive excretion of potassium from the body (leading to hypokalemia).
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The homeostasis between the presence of calcium and phosphate ions in the body becomes disturbed after sodium bicarbonate intake. Thus, an increased incidence of calcium phosphate renal calculi is noted among patients.
What Are the Alternate Treatment Options for Sodium Bicarbonate?
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The objective of reducing the acid load in the body in metabolic acidosis can be achieved through consuming fruits and vegetables.
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Bicarbonate precursors are great options for managing metabolic acidosis. Some examples of such compounds are sodium or potassium citrate, which have fewer adverse effects.
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For patients who have advanced-stage kidney disease or renal failure, dialysis is the only option, and sodium bicarbonate is not indicated for such patients.
Conclusion
Treating kidney disease and associated metabolic acidosis with sodium bicarbonate can be a great management strategy and help restore the body's acid-base balance. However, going overboard with the treatment can also cause hypernatremia and associated cardiac complications. Hence, treatment with sodium bicarbonate requires an individualized approach for a better prognosis.
