Veverimer in treating metabolic acidosis in chronic kidney disease patients: a systematic review and meta-analysis of randomized clinical trials

Chronic kidney failure (CKD), a common cause of mortality, impacts about 800 million individuals globally. Metabolic acidosis, which occurs in 20% of people with CKD, complicates the course of CKD and increases the possibility of morbidity and mortality in these patients. Veverimer, a promising experimental acid-binding polymer that may be taken orally and has a high capacity, presents a unique method for the management of metabolic acidosis conditions in CKD patients. This study aimed to assess the safety and effectiveness of veverimer compared to placebo by analysing data from randomised controlled trials. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases searched included PubMed, Scopus, Web of Science, Embase, clinicaltrials.gov, and Cochrane CENTRAL until April 24th, 2025. Our analysis comprised randomised controlled trials that assessed the impact of veverimer on patients with CKD and metabolic acidosis. Quality assessment was performed using the Joanna Briggs Institute (JBI) assessment. Four studies met the inclusion criteria. A total of 1083 participants were randomly assigned to receive veverimer, whereas 945 participants were given a placebo. Veverimer was able to significantly increase serum bicarbonate compared to the placebo group (mean difference = 2.90 mmol/L (95% CI: 2.15 to 3.65, p < 0.01)). The adverse events in the veverimer group did not differ significantly from the placebo group. Meta-regression showed that mean age and mean GFR did not have a statistically significant association with the treatment effect. In conclusion, our study offers robust support for the use of veverimer in treating metabolic acidosis, while also identifying areas that require additional investigation. The results of this study may inform future research and clinical practices in managing metabolic acidosis. N/A.