One-Year Conservative Care Using Sodium Bicarbonate Supplementation Is Associated with a Decrease in Electronegative LDL in Chronic Kidney Disease Patients: A Pilot Study

Cardiorenal medicine

· Barra A.B.¹  · Pires de Melo G.¹  · Leite Jr. M.²  Rizzetto F.³  · Mafra D.⁴  · Abdalla D.S.P.⁵ 

[1] Division of Nephrology, Federal Hospital of Lagoa (FHL), Rio de Janeiro,;Division of Nephrology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil;Division of Nutrition, Federal Hospital of Lagoa (FHL), Rio de Janeiro,;Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói,;School of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, and

关键词: Chronic kidney disease;    Alkali therapy;    Electronegative LDL;    Cardiovascular diseases;   

DOI  :  10.1159/000478733

学科分类：心脏病和心血管学

来源: S Karger AG

【 摘 要 】

Background: Chronic kidney disease (CKD) patients develop metabolic acidosis when approaching stages 3 and 4, a period in which accelerated atherogenesis may ensue. Studies in vitro show that low pH may increase low-density lipoprotein (LDL) oxidation, suggesting a role for chronic metabolic acidosis in atherosclerosis. The present study attempted to evaluate the effects of conservative care using oral sodium bicarbonate (NaHCO3) supplementation on the electronegative LDL [LDL(-)], a minimally oxidized LDL, plasma levels in CKD patients. Methods: Thirty-one CKD patients were followed by a multidisciplinary team during 15 months of care in which 1.0 mmol/kg/day oral NaHCO3 supplementation was first given in the third month. Blood samples were collected 3 months before the initiation of oral NaHCO3 supplementation (T1), at the time of the beginning of supplementation (T2), and thereafter, each 4 months (T3, T4 and T5) until month 15 of care. Blood parameters and LDL(-) were measured from these collections. Results: After 12 months of conservative care, creatinine clearance (MDRD) was kept stable, and serum bicarbonate (HCO3-) increased from 20.5 ± 2.9 to 22.6 ± 1.1 mM (p < 0.003). LDL(-) plasma levels declined from 4.5 ± 3.3 to 2.1 ± 0.9 U/L (p < 0.007) after reaching mean serum HCO3- levels of 22.6 ± 1.1 mM. Conclusions: Conservative care using oral NaHCO3 supplementation was able to stabilize renal function and decrease serum levels of LDL(-), a modified proatherogenic lipoprotein, only when mean serum HCO3- levels approached 22 mM. This study constitutes evidence that alkali therapy, in addition to its beneficial effect on renal disease progression, might serve as a preventive strategy to attenuate atherogenesis in CKD patients.

【 授权许可】

CC BY