Study of the Effect of HCO3 Supplementation on Serum α-Klotho Protein Level in Diabetic Kidney Disease. Pilot Study

Abstract Background Chronic kidney disease (CKD) was prevalent worldwide in the middle-aged and old-aged population. It has been recognized as an important disease threatening human health. Individuals with CKD are at risk of bone disorders, vascular abnormalities, and premature mortality due to changes in Ca2 and PO4 haemostasis. Aim of the Work To study the effect of oral sodium bicarbonate supplementation on soluble α-Klotho serum levels in diabetic patients with chronic kidney disease (stage 3b:4) according to the CKD-EPI formula. Patients and Methods This study was conducted on 44 diabetic patients with CKD stages 3b-4 according to the CKD-EPI formula ESRD recruited from Inward and OPC patients at El-Demerdash Internal Medicine Hospital. Their age ranged from 26 to 76 year. This study was conducted from June 2023 to November 2023; each participant signed informed consent. The study was approved by the Research Ethical Committee of Faculty of Medicine, Ain Shams University in April 2023. Results The mean age in cases was 57.1 ± 12.9 years was comparable to the control 55.1 ± 11.3 years with no significant difference between groups (p > 0.05). As regard sex distribution of the 44 patients included, males were 45.5% and females 54.5% with no significant difference between groups (p > 0.05). In our study there was no statistically significant difference between the two groups regarding DM duration (p > 0.05) or treatment also regarding presence of HTN or antihypertensive (p > 0.05). Also results showed no significant difference between cases and control as regard serum creatinine, eGFR, calcium, phosphorus, PTH and HBA1c (p > 0.05). As regards p/c ratio, there was significant difference between cases and control (P < 0.05). An interesting finding in this work was the significant increase in serum alpha klotho after 6 months of HCO3 supplementation, The Klotho (pg/mL) Before ranged from 296.1 to 730.2 with mean 388.5 ± 100.6 and the Klotho (pg/mL) After ranged from 426.1 to 933.3 with mean 641.5 ± 131.1. Conclusion There was highly significant difference found between before and after sodium bicarbonate supplementation in terms of Klotho and Hco3 in chronic kidney disease patients stage 3b to 4.