EFFECT OF ORAL SODIUM BICARBONATE SUPPLEMENTATION ON CORRECTED QT INTERVAL IN PATIENTS WITH CKD STAGES 3–5

Abstract

Objective: To determine the effect of Oral Sodium Bicarbonate Supplementation on corrected QT Interval in Patients with Chronic kidney disease (CKD) Stages 3–5.

Place and Duration of Study: Nephrology Department of  CMH Peshawar, a tertiary academic center, between June 2024-November 2024.

Methodology: A prospective observational study was conducted on 96 patients with CKD stages 3–5 and baseline metabolic acidosis. All patients received oral sodium bicarbonate supplementation titrated to achieve a target serum bicarbonate ≥22 mmol/L. Biochemical parameters and 12-lead ECG recordings were obtained at baseline and post-treatment. The primary outcome was the change in QTc interval, with secondary outcomes including QT, QT dispersion (QTd), and QTcd.

Results: The mean age of participants was 62.04±7.66 years, with 54(56.3%) females. Sodium bicarbonate therapy significantly corrected metabolic acidosis, increasing serum bicarbonate from 17.55±1.80 to 22.29±1.34 mmol/L (p < 0.001) and pH from 7.27±0.04 to 7.33±0.04 (p < 0.001). QTc interval decreased from 459.72±25.47 ms to 448.49 ± 23.62 ms (p = 0.004). Similarly, the QT interval reduced from 410.47 ± 34.11 ms to 399.92±31.97 ms (p = 0.030). Electrical heterogeneity improved, with QTd declining from 46.03±16.36 ms to 33.08±11.12 ms (p < 0.001) and QTcd from 46.46±16.67 ms to 36.25±15.60 ms (p < 0.001). Minor increases in creatinine and potassium were observed.

Conclusion: These findings highlight the potential role of bicarbonate therapy in reducing arrhythmogenic risk in this high-risk population. Further randomized trials are needed to validate its long-term cardiovascular benefits.