is associated with a higher risk of elevated systolic BP, marking a potential side effect. Background In patients with CKD, impaired kidney acid excretion leads to the onset of metabolic acidosis (MA). However, the evidence is not yet conclusive regarding the effects of sodium bicarbonate in treating CKD with MA. Methods Databases with PubMed, Embase, and the Cochrane Library were used to search for randomized controlled trials (RCTs) from the inception until November 11, 2023, to identify RCTs investigating the effect of sodium bicarbonate in participants with CKD and MA. The primary outcome was the change in eGFR. Secondary outcomes included hospitalization rates, change in systolic BP, all-cause mortality, and mid-arm muscle circumference. A random-effects model was applied for analysis, and subgroup, sensitivity analyses were also performed. Results Fourteen RCTs comprising 2037 patients demonstrated that sodium bicarbonate supplementation significantly improved eGFR (standardized mean difference [SMD], 0.33; 95% confidence interval [CI], 0.03 to 0.63; P = 0.03). The group receiving sodium bicarbonate had a lower hospitalization rate (odds ratio, 0.37; 95% CI, 0.25 to 0.55; P < 0.001). Higher mid-arm muscle circumference was observed with sodium bicarbonate treatment compared with those without (SMD, 0.23; 95% CI, 0.08 to 0.38; P = 0.003, I2<0.001). However, higher risk of elevated systolic BP was found with sodium bicarbonate treatment (SMD, 0.10; 95% CI, 0.01 to 0.20; P = 0.03). No significant difference in all-cause mortality was noted. Conclusions In patients with CKD and MA, sodium bicarbonate supplementation may provide potential benefits in preventing the deterioration of kidney function and increasing muscle mass. However, treatment may be associated with higher BP. Owing to the risk of bias stemming from the absence of double-blinded designs and inconsistencies in control group definitions across the studies, further research is crucial to verify these findings....

中文翻译：

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碳酸氢钠治疗慢性肾病合并代谢性酸中毒的临床结果：荟萃分析


与收缩压升高的较高风险相关，这是潜在的副作用。背景 在 CKD 患者中，肾脏酸排泄受损会导致代谢性酸中毒 (MA) 的发生。然而，关于碳酸氢钠在 MA 治疗 CKD 中的效果尚无定论。方法 使用 PubMed、Embase 和 Cochrane 图书馆的数据库来搜索从开始到 2023 年 11 月 11 日的随机对照试验 (RCT)，以确定研究碳酸氢钠对 CKD 和 MA 参与者的影响的 RCT。主要结果是 eGFR 的变化。次要结局包括住院率、收缩压变化、全因死亡率和中臂肌围。应用随机效应模型进行分析，并进行亚组敏感性分析。结果 包含 2037 名患者的 14 项随机对照试验表明，补充碳酸氢钠可显着改善 eGFR（标准化平均差 [S​​MD]，0.33；95% 置信区间 [CI]，0.03 至 0.63；P = 0.03）。接受碳酸氢钠治疗的组住院率较低（比值比，0.37；95% CI，0.25至0.55；P < 0.001）。与未接受碳酸氢钠治疗的患者相比，接受碳酸氢钠治疗的患者中臂肌肉周长更高（SMD，0.23；95% CI，0.08 至 0.38；P = 0.003，I2<0.001）。然而，碳酸氢钠治疗发现收缩压升高的风险更高（SMD，0.10；95% CI，0.01至0.20；P = 0.03）。全因死亡率没有显着差异。结论 对于 CKD 和 MA 患者，补充碳酸氢钠可能对预防肾功能恶化和增加肌肉质量具有潜在益处。 然而，治疗可能会导致血压升高。由于缺乏双盲设计以及研究中对照组定义不一致而产生偏倚风险，进一步的研究对于验证这些发现至关重要......