Metabolic Acidosis and Vascular Function in Patients With Chronic Kidney Disease

Not Applicable

Completed

Brief Summary: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) and large artery damage is a major factor that contributes to death. Metabolic acidosis is a common complication of CKD resulting from an inability of the diseased kidney to excrete the daily dietary acid load and it is associated with all-cause mortality in patients with CKD. However, the effect of treatment of metabolic acidosis with oral sodium bicarbonate on endothelial dysfunction and arterial stiffness in patients with CKD has not been evaluated. The investigators propose a prospective, randomized, controlled, open-label 14-week crossover pilot study examining the effect of treatment of metabolic acidosis with oral sodium bicarbonate on vascular endothelial function in 20 patients with CKD stage IV with metabolic acidosis.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Significant comorbid conditions that lead the investigator to conclude that life expectancy is less than 1 year
Uncontrolled hypertension
Expected to undergo living related kidney transplant in next 6 months
Expected to start dialysis in next 3 months
Overt congestive heart failure
Use of sevelamer
Use of calcium carbonate

Arm && Interventions

Group	Intervention	Description
A: Treatment/Control	Control	Patients will start with sodium bicarbonate treatment then switch to control (no treatment)
B: Control/Treatment	Control	Patients will start with control (no treatment) then switch to sodium bicarbonate treatment
A: Treatment/Control	Sodium bicarbonate	Patients will start with sodium bicarbonate treatment then switch to control (no treatment)
B: Control/Treatment	Sodium bicarbonate	Patients will start with control (no treatment) then switch to sodium bicarbonate treatment

Primary Outcome Measures

Name	Time	Method
Change in Brachial Artery Flow Mediated Dilation (FMD)	6 weeks and 12 weeks	The primary endpoint is change in brachial artery FMD between treatment and control conditions. Each treatment period is 6 weeks in duration with a 2 week washout period in between. Outcome measures will be repeated at the beginning and end of each period.

Secondary Outcome Measures