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.