(P30-001-23) Effects of Oral Sodium Bicarbonate Supplementation on Protein Metabolism and Inflammation in Iraqi Hemodialysis Patients: An Open-Label Randomized Controlled Trial

Objectives: To study the effects of oral sodium bicarbonate on protein metabolism and markers of inflammation in acidotic hemodialysis patients.

Methods: Open-label randomized controlled trial was conducted at a single center. Sixty-six clinically stable adult hemodialysis patients were recruited with pre-dialysis serum bicarbonate level of < 22mmol/l and a dialysate bicarbonate concentration of 35 mmol/l. Forty-nine participants completed the study. Oral sodium bicarbonate tablets of 500 mg were given in the intervention group (n=25) for 12 weeks versus the standard of care in the control group (n=24). Outcomes compared intervention vs. non-intervention at equivalent time points (0 and 3 months). Clinical data, anthropometry, dialysis adequacy, albumin, normalized protein catabolism rate, PH, and bicarbonate were recorded at 0 and 3 months. Muscle mass and handgrip strength were measured. As a marker of inflammation, IL-6; was measured at randomization and three months.

Results: Serum bicarbonate and pH increased significantly from 17.57±3.34 mmol/L to 20.69±2.54 mmol/L and from 7.26±0.06 to 7.34±0.04, respectively (P < .0001). Serum albumin was significantly higher in the intervention group at M3 than in the control group, 4.11±0.45 vs. 3.79±0.47 (p-value 0.011). Serum potassium significantly decreased in the intervention group at M3 compared to the control, 5.00±0.43 meq/l vs. 5.33±0.63 meq/l (p-value 0.03). Muscle strength expressed as handgrip has improved significantly in the intervention group at M3 compared to the control , 45.01±19.19 vs. 33.93±15.06 (p-value 0.03). There was no statistically significant difference in the IL-6 values in the intervention group at M3 (p-value of 0.69), but this was significantly lower than the control group at M3, 12.34±10.62 vs. 22.88±16.79 (p-value 0.043). The interdialytic weight of the intervention group at M3 was 2.42±0.64 compared to the 2.20±1.14 control group, but this didn’t reach statistical significance (p-value of 0.4). The Composite of (Albumin +nPCR) at M3 was achieved in 59.18% of the intervention group compared to 14.28% with a p-value of 0.01.

Conclusions: Correcting metabolic acidosis in hemodialysis patients improved serum albumin and nPCR without hypokalemia or significant interdialytic weight gain. This was particularly evident in less inflamed patients.

Funding Sources: Self-funding.