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Thursday, 19 May 2016 14:09

Clinical Research: Limiting progression to end stage kidney failure with sodium bicarbonate therapy : A preliminary report from a developing country

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image okunolaName: OLUYOMI OKUNOLA

Hospital / Affiliation: Obafemi Awolowo University Teaching Hospital, ILE-IFE.

Home Country: NIGERIA

Host Country: NIGERIA

Year: 2012

Status of your program: COMPLETED

 

 

Title of the project: 

Limiting progression to end stage kidney failure with sodium bicarbonate therapy :
A preliminary report from a developing country

Topic: 

Chronic Kidney disease

 

Short description of the project or abstract:

The incidence of CKD in adult Nigerians has risen from 10 to 18.8%. 
In Nigeria, end stage renal disease is a serious public health challenge. The access to renal replacement therapy is limited and mortality rates are very high, up to 100% in most cases because less than 5% of the patients can afford the cost of haemodialysis for more than 3 months. In recent studies, administration of alkali have also been found to reduce muscle degradation, improve albumin synthesis and reducing the progression of bone diseases. The burden of renal replacement therapy in sub Saharan Africa is quite enormous, the infrastructures are grossly inadequate and the cost is barely affordable for a large majority of people with end stage kidney failure in a developing economy. It is envisaged that with the wide use of less cost intensive therapy such as sodium bicarbonate treatment most especially as an adjunct therapy to standard treatment in developing countries, progression to ESKD (end-stage kidney disease) would be reduced in a majority of our pre-dialytic patients. Using block randomization method, a total number of 63 adults above the age of 18 years in stage 4 CKD with established metabolic acidosis i.e serum bicarbonate between 16mmol/l and 20 mmol/l measured on two consecutive occasions and in stable clinical condition were recruited for the study after an informed consent.

The study was conducted over a 24-month period. There was a moderate increase in the mean creatinine clearance in the subjects arm. There was a noticeable rise in the bicarbonate serum in the subjects.
From a mean value of 20.5mmol/l at the beginning of the study to 22.3mmol/l at the end amongst the subjects as compared with 20.8mmol/l at commencement and 20.5mmol/l amongst the controls after 24 months.
Protein excretion levels using the 24 hour protein estimation was slightly increased among both the subjects and the controls from 1.25g/24hours at baseline to 1.47g/24 hours for the former and from 0.90g to 1.14g/24hours amongst the controls at the end of the study .
The serum albumin level was used as a surrogate of nutritional level and there was a noticeable increase from a mean value of 33g/dl at baseline to 35.1g/dl for the subjects at the end of the study. (p value of 0.047).
There was no effect on the mean haemoglobin levels in both subject and the controls as both groups had comparatively similar levels of 8g/dl and 7.5g/dl at the onset and 6.5g/dl and 6g/dl respectively.

14 patients out of 31 controls progressed to end stage kidney failure while 5 out of 32 in the subjects group had progressed to end stage. (95% confidence interval of -1.90 to 1.22). Only 1 patient amongst the subjects reported of a transient episode of severe bloating. No other adverse drug reaction (to bicarbonate) was reported at each follow up.

 

Learning or Research objectives:

  • beneficiate the effects of sodium bicarbonate therapy in pre dialytic CKD patient,
  • determine the role of sodium bicarbonate therapy in improving the nutritional parameters of patients in stage4
  • determine the capacity of sodium bicarbonate therapy in retarding progression to ESRD and, (iv)to determine the effects between sodium bicarbonate treatment on biochemical parameters such as albumin and calcium, phosphates

 

Additional Info

  • Year: 2012
  • Status: Completed
  • Partners: ISN only
  • Region: Africa
  • Country: Nigeria
  • Topics: CKD
Read 7233 times Last modified on Friday, 17 February 2017 12:19

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