Hi, My husband is a sporadic diabetic. He had bypass surgery in 2005. Over the course of this past year, he started seeing a nephrologist for his kidneys. The doctor put him on sodium bicarbonate and at first numbers improved. We transitioned from the sodium bicarbonate tablets to baking soda 1/4 tsp per gallon of water on two weeks off two weeks. His numbers improved upon the first test after adjustments according to his doctor then the next test he showed too much sodium and we were told to cut back on his salt. We immediately cut down on adding the baking soda because we are already on a strict salt diet and this week were told he needed the sodium bicarbonate added back into his diet “he wasn’t getting enough”. His doctor is adding three tablets to his daily medications and when I asked about getting too much sodium and his heart health her response was that most kidney patients die from heart attacks. She is also suggesting he begin initiating the process to prepare for dialysis by taking a training course and getting vein mapping so they can schedule an appointment for surgery. I am going to request copies of all his blood work results Monday. She indicated his latest test was at 22 points gfr and that it had decreased 7 points from the prior test. before that it had increased and looked good but the only concern she had during the last appointment was his sodium levels. I have four questions. * It seems everyone is affiliated for several cities away and we would like a second opinion about getting dialysis. How do we go about getting this completed and can you help us after we get a hard copy of the test results? * What is your take on sodium bicarbonate? Is this the only thing that can help the kidney numbers improved outside of diets and dialysis (low potassium diet, low carb diet, etc.) His potassium levels are within normal range and his carbs are doing better than they ever running around 120 to 150. He used to have numbers into high 300 and low 400 for carbs.) Kidney disease is chronic and a direct result of his diabetes according to a number of medical health professionals. * Are there other options for stages three and four kidney disease? The only difference in medications lie in his vitamin D, calcitriol, and sodium bicarbonate. Yes he has low vitamin D levels too. He has moved between the two stages over the past year. When he was first diagnosed he was in stage 4 and we were told the numbers would not improve but after removing a large amount of protein he dropped to stage three but is now back to stage 4 since we reduced sodium levels via baking soda. * Is there a medication for the kidneys rather than going directly to dialysis that would work to slow the decline and possibly improve filtration? Example he had been put on a high protein diet when he had to have an amputation due to diabetes. We were never told to reduce the protein levels down until we moved and he ended up in the hospital here. As I mentioned earlier his numbers improved greatly after cutting out the high level of proteins that were meant to help him heal. I simply would like to know if there are other options, if so how well do they work? My husband has no swelling in the legs either. * Are there any contraindications for dialysis? I see on the web that primary concerns revolve around mental health issues and cancer issues which we are not affected with at this time.

You ask a number of questions that I am unable to answer without performing a complete history and physical examination.  Your husband has chronic kidney disease (CKD) and his diabetes, heart disease, high blood pressure and peripheral vascular disease make his treatment very complicated.

Sodium bicarbonate is used to treat acid levels in the blood. It is not used to treat sodium levels in the blood.  The acid levels are reflected in the amount of carbon dioxide (CO2) that is found in the blood.  If the CO2 is less than 22 milliequivalents per liter (mEq/L), the baking soda powder or tablets are administered.  The goal is to keep the CO2 greater than 21.

I recommend that you discuss your concerns with your husband’s physician and nephrologist.


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