Sodium citrate versus sodium bicarbonate for metabolic acidosis in patients with chronic kidney disease: A randomized controlled trial.

"The authors have no funding and conflicts of interest to disclose."

"The authors have no funding and conflicts of interest to disclose."

"This study was a prospective, single-center, randomized 1:1, parallel, controlled, and unblinded clinical trial. The trial was approved by the Ethics Committee of Fundeni Clinical Institute (date of approval September 20, 2021, no. 59531) and registered in the ISRCTN registry (registration date: September 22, 2021, no. 16429332, https://doi.org/10.1186/ISRCTN16429332). All patients with CKD stage G3b-G4 and MA evaluated in the Nephrology Department of Fundeni Clinical Institute between October 2021 and October 2022, who met the study inclusion criteria, were enrolled (Fig. ). Inclusion criteria were: age > 18 years, estimated GFR (eGFR) between 45 and 15 mL/min/1.73 m2, serum bicarbonate between 10 and 22 mmol/L on two separate measurements, ability to follow the study treatment regimen, and a wash-out period of 1 month if previous alkali therapy was used (sodium bicarbonate, sodium citrate, potassium citrate, baking soda, etc.). Exclusion criteria included hypokalemia < 3 mmol/L, uncontrolled high blood pressure (>150/90 mm Hg under treatment with more than 3 different classes of antihypertensive drugs, including diuretics), heart failure with active class III or IV New York Heart Association, known left ventricular ejection fraction ≤ 30% or hospital admission for heart failure within the past 3 months, hypervolemia of any cause (nephrotic syndrome, liver, or heart failure) considered unsafe, active hepatic disease, chronic gastrointestinal disorder (treatment adherence unreliable), active malignancy, pregnancy, patients taking amiloride or sevelamer, and patients who refused to sign the informed consent. The trial was approved by the Ethics Committee of Fundeni Clinical Institute (date of approval September 20, 2021, no. 59531) and registered in the ISRCTN registry (registration date: September 22, 2021, no. 16429332; https://doi.org/10.1186/ISRCTN16429332)."