A Comparison of Sodium Citrate and Sodium Bicarbonate's Safety and Effectiveness in Treating Metabolic Acidosis in Patients with Chronic Renal Disease

Our aim was to compare the safety and effectiveness of sodium citrate and sodium bicarbonate in patients with metabolic acidosis of chronic kidney disease. Patients who were reviewed in Hospitals of United Arab Emirates and Bangladesh between June 2023 and June 2024 and who met the inclusion criteria for the study were evaluated. Patients with chronic kidney disease (CKD) stage G3b-G4 and metabolic acidosis were included in the study. The main outcome was mean eGFR change after six months of treatment, with secondary outcomes including serum bicarbonate levels, renal failure, and dialysis, death, and medication safety. Patients were randomized to either group using a computer-generated random-number generator. Data analysis was performed using SPSS 25. The study had a mean age of 57.95 years, with a standard deviation of 10.22 years, and 55.5% of the participants were male. Approximately half of the patients were receiving antihypertensive medication with angiotensin conversion enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) at the beginning of the study. The study found that both sodium citrate and sodium bicarbonate patients experienced significant changes in serum bicarbonate levels after treatment. However, the adjusted mean difference did not show significant differences. The Cox proportional-hazard analysis showed similar risks in terms of eGFR drop, dialysis, death, prolonged hospitalization, and combined endpoint. The sodium bicarbonate group showed signs of metabolic alkalosis and higher gastrointestinal events, but not statistically significant. Although SB is associated with a higher likelihood of prescription cessation due to adverse events, both SC and SB raise serum bicarbonate levels and slow the loss in kidney effectiveness.