Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- Oral sodium bicarbonate should be administered to maintain the serum bicarbonate above 22 mmol/L. (Level III evidence) Sodium bicarbonate is preferred to sodium citrate if the patient is also on aluminium phosphate binders.
Oral sodium bicarbonate in a total daily dose of 0.5 –1.0 mmol per kg body weight per day, in divided doses two to three times a day (tailored to the individual patient's tolerance) should be administered to maintain the serum bicarbonate above 22 mmol/L.
Oral bicarbonate is available as the sodium salt. The amount of bicarbonate required to correct the acidosis often results in a sodium load that may exacerbate the patient's hypertension or oedematous state. A balance between the benefits of correction of the acidosis, and the risks of excessive sodium loading has to be made for each individual.
Each 4 g Ural sachet contains 28 mmol of sodium. Each sodium bicarbonate tablet contains 10 mmol of sodium/tablet. One teaspoon (approximately 5 g) of baking soda in 60 mL of water produces 1 mmol HCO3/mL (see the National Guideline Clearinghouse [NGC] summary of the Caring for Australians with Renal Impairment guideline sodium in pre-dialysis patients for sodium content).
Correction of metabolic acidosis in severe renal failure is desirable to minimize skeletal muscle breakdown and the associated negative nitrogen balance.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test