Chronic Kidney Disease

CKD: Acid-Base Balance (2018)

Intervention
What is the effect of acid-base interventions on hospitalizations and mortality in adults with CKD 1-5D and post-transplant?
- Conclusion
  One study noted lower hospital admission and hospital length of stay in peritoneal dialysis patients, while another study reported no significant difference in pre-dialysis patients. Mortality was not significantly different according to intervention group, but there was limited statistical power, in peritoneal dialysis patients.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on hospitalizations and mortality in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on blood pressure in adults with CKD 1-5D and post-transplant?
- Conclusion
  In pre-dialysis CKD patients, fruit and vegetable intake reduced blood pressure but in pre-dialysis and hemodialysis patients, oral bicarbonate supplement did not have effects on blood pressure in most studies.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on blood pressure in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions or NEAP/acid load levels on CKD progression in adults with CKD 1-5D and post-transplant?
- Conclusion
  In pre-dialysis CKD patients, fruit and vegetable group and oral bicarbonate supplement had beneficial effects of oral bicarbonate on CKD progression. Greater NEAP/acid load levels were associated with greater CKD progression.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions or NEAP/acid load levels on CKD progression in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on acid-base levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis, peritoneal dialysis, and hemodialysis patients, fruit and vegetable group and oral bicarbonate supplement had favorable effects on acid-base biomarkers in all studies.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on acid-base levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on fluid status in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis and peritoneal dialysis patients, oral bicarbonate supplements had no effect on fluid status in two studies.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on fluid status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on body weight/BMI in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis patients, the fruit and vegetable group had significantly greater decreases in body weight while in pre-dialysis and hemodialysis patients, oral bicarbonate supplement was not associated with greater decreases in body weight or BMI in all studies.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on body weight/BMI in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on MAMC/TSF in adults with CKD 1-5D and post-transplant?
- Conclusion
  One study noted significant increases in mid arm muscle circumference (MAMC) measurements with oral sodium bicarbonate in CKD pre-dialysis patients, while another study did not in hemodialysis patients. In hemodialysis patients, oral bicarbonate supplement were not associated with greater decreases in triceps skinfold thickness (TSF) in one study.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on MAMC/TSF in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on CRP levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  In pre-dialysis CKD patients, oral bicarbonate supplements did not have an effect on c-reactive protein (CRP) level in one study.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on CRP levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on nutritional status indicators in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis, peritoneal dialysis, and hemodialysis patients, oral bicarbonate supplements improved nutrition status (e.g., SGA scores, albumin, and prealbumin) in most studies.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on nutritional status indicators in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on nPNA in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis patients, oral bicarbonate supplements decreased nPNA in one study.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on nPNA in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    de Brito-Ashurst I, Varagunam M, Raftery M, Yaqoob M. Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status. Journal of the American Society of Nephrology 2009; 20:2075-84
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)
What is the effect of acid-base interventions on caloric and protein intakes in adults with CKD 1-5D and post-transplant?
- Conclusion
  In CKD pre-dialysis and hemodialysis patients, two studies reported no significant effects of oral bicarbonate supplements on both caloric and protein intakes but one study observed a significant positive effect of oral bicarbonate supplements on dietary protein intake.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of acid-base interventions on caloric and protein intakes in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Electrolytes: Acid-base (2018)