Sodium bicarbonate (NaHCO 3 ) prescription and extracellular volume increase: real‐world data results from the AlcalUN study - Sorbonne Université Access content directly
Journal Articles Clinical Pharmacology and Therapeutics Year : 2021

Sodium bicarbonate (NaHCO 3 ) prescription and extracellular volume increase: real‐world data results from the AlcalUN study

Lisa Belaïd
  • Function : Author

Abstract

Oral alkalization with sodium bicarbonate (NaHCO3) or citrate is prescribed for conditions ranging from metabolic acidosis to nephrolithiasis. While most nephrologists/urologists use this method routinely, extracellular volume (ECV) increase is the main feared adverse event reported for NaHCO3. Thus far, no trial has specifically studied this issue in a real-world setting. AlcalUN (NCT03035812) is a multicentric, prospective, open-label cohort study with nationwide (France) enrollment in 18 (public and private) nephrology/urology units. Participants were adult outpatients requiring chronic (>1 month) oral alkalization by either NaHCO3-containing or no-NaHCO3-containing agents. The ECV increase (primary outcome) was judged based on body weight increase (ΔBW), blood pressure increase (ΔBP), and/or new-onset edema at the first follow-up visit (V1). From 02/2017 to 02/2020, 156 patients were enrolled. After a median 106 days of treatment, 91 (72%) patients reached the primary outcome. They had lower systolic (135 [125, 141] vs. 141 [130, 150], p=0.02) and diastolic (77 [67, 85] vs. 85 [73, 90], p=0.03) BP values, a higher plasma chloride (106.0 [105.0, 109.0] vs. 105.0 [102.0, 107.0], p=0.02) at baseline, and a less frequent history of nephrolithiasis (32 vs. 56%, p=0.02). Patients experienced mainly slight increases in blood pressure (ΔBP<10 mmHg). The primary outcome was not associated (p=0.79) with the study treatment (129 received NaHCO3, 27 received citrate). We subsequently developed 3 different models of propensity score matching; each confirmed our results. Chronic oral alkalization with NaHCO3 is no longer associated with an ECV increase compared to citrate in real-life settings.
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Dates and versions

hal-03366548 , version 1 (05-10-2021)
hal-03366548 , version 2 (27-09-2023)

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Julie Beaume, Lucile Figueres, Mickaël Bobot, Louis de Laforcade, Hamza Ayari, et al.. Sodium bicarbonate (NaHCO 3 ) prescription and extracellular volume increase: real‐world data results from the AlcalUN study. Clinical Pharmacology and Therapeutics, 2021, 111 (1), pp.252-262. ⟨10.1002/cpt.2427⟩. ⟨hal-03366548v2⟩
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