Document Detail


Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy.
MedLine Citation:
PMID:  20445497     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In most patients with hypertensive nephropathy and low glomerular filtration rate (GFR), the kidney function progressively declines despite the adequate control of the hypertension with angiotensin-converting enzyme inhibition. Previously we found that 2 years of oral sodium citrate slowed GFR decline in patients whose estimated GFR (eGFR) was very low (mean 33 ml/min). This treatment also slowed GFR decline in an animal model of surgically reduced nephron mass. Here, we tested if daily oral sodium bicarbonate slowed GFR decline in patients with hypertensive nephropathy with reduced but relatively preserved eGFR (mean 75 ml/min) in a 5-year, prospective, randomized, placebo-controlled, and blinded interventional study. Patients matched for age, ethnicity, albuminuria, and eGFR received daily placebo or equimolar sodium chloride or bicarbonate while maintaining antihypertensive regimens (including angiotensin-converting enzyme inhibition) aiming for their recommended blood pressure targets. After 5 years, the rate of eGFR decline, estimated using plasma cystatin C, was slower and eGFR was higher in patients given sodium bicarbonate than in those given placebo or sodium chloride. Thus, our study shows that in hypertensive nephropathy, daily sodium bicarbonate is an effective kidney protective adjunct to blood pressure control along with angiotensin-converting enzyme inhibition.
Authors:
Ashutosh Mahajan; Jan Simoni; Simon J Sheather; Kristine R Broglio; M H Rajab; Donald E Wesson
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-05-05
Journal Detail:
Title:  Kidney international     Volume:  78     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-15     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  303-9     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Texas A&M College of Medicine, Temple, Texas 76508, USA.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Albuminuria / drug therapy,  physiopathology
Angiotensin-Converting Enzyme Inhibitors / pharmacology,  therapeutic use
Antihypertensive Agents / pharmacology,  therapeutic use
Blood Pressure / drug effects
Cystatin C / blood
Double-Blind Method
Drug Therapy, Combination
Female
Glomerular Filtration Rate / drug effects*
Humans
Hypertension / complications*,  drug therapy,  physiopathology
Kidney / drug effects,  physiopathology
Kidney Diseases / drug therapy*,  etiology*,  physiopathology
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Sodium Bicarbonate / administration & dosage,  pharmacology*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Cystatin C; 144-55-8/Sodium Bicarbonate
Comments/Corrections
Comment In:
Kidney Int. 2010 Oct;78(8):817; author reply 817-8   [PMID:  20877374 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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