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Therefore, we hypothesized that sodium bicarbonate supplementation reduces urinary renin excretion in patients with chronic kidney disease (CKD) and metabolic acidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with CKD stage G4 and plasma bicarbonate 15\u201324\u00a0mmol\/l were randomized to receive sodium bicarbonate (3\u2009\u00d7\u20091000\u00a0mg\/day,\u2009~\u20090.5\u00a0mEq\/kg), sodium chloride (2\u2009\u00d7\u20091,00\u00a0mg\/day), or no treatment for 4\u00a0weeks (n\u2009=\u200915\/arm). The effects on urinary renin excretion (primary outcome), other plasma and urine parameters of the renin-angiotensin system, endothelin-1, and proteinuria were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-five patients were included (62\u2009\u00b1\u200915\u00a0years, eGFR 21\u2009\u00b1\u20095\u00a0ml\/min\/1.73m2, plasma bicarbonate 21.7\u2009\u00b1\u20093.3\u00a0mmol\/l). Sodium bicarbonate supplementation increased plasma bicarbonate (20.8 to 23.8\u00a0mmol\/l) and reduced urinary ammonium excretion (15 to 8\u00a0mmol\/day, both P\u2009&amp;lt;\u20090.05). Furthermore, a trend towards lower plasma aldosterone (291 to 204\u00a0ng\/L, P\u2009=\u20090.07) and potassium (5.1 to 4.8\u00a0mmol\/l, P\u2009=\u20090.06) was observed in patients receiving sodium bicarbonate. Sodium bicarbonate did not significantly change the urinary excretion of renin, angiotensinogen, aldosterone, endothelin-1, albumin, or \u03b11-microglobulin. Sodium chloride supplementation reduced plasma renin (166 to 122\u00a0ng\/L), and increased the urinary excretions of angiotensinogen, albumin, and \u03b11-microglobulin (all P\u2009&amp;lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite correction of acidosis and reduction in urinary ammonium excretion, sodium bicarbonate supplementation did not improve urinary markers of the renin-angiotensin system, endothelin-1, or proteinuria. Possible explanations include bicarbonate dose, short treatment time, or the inability of urinary renin to reflect intrarenal renin-angiotensin system activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphic abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-020-00944-5","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T05:02:25Z","timestamp":1609390945000},"page":"1737-1745","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Effect of sodium bicarbonate supplementation on the renin-angiotensin system in patients with chronic kidney disease and acidosis: a randomized clinical trial"],"prefix":"10.1093","volume":"34","author":[{"given":"Dominique M.","family":"Bov\u00e9e","sequence":"first","affiliation":[{"name":"Divisions of Nephrology & Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, PO Box 2040 Room Ns403, 3000, Rotterdam, CA, The Netherlands 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lodi C. 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