A Cochrane review [Abstract] 1 included 3 trials involving a total of 117 adult dialysis patients. There were insufficient data for most outcomes for meta-analysis. In all three trials acidosis improved in the intervention group though there was variation in achieved bicarbonate level. There was no evidence of effect on blood pressure or sodium levels. Some measures of nutritional status/protein metabolism were improved by correction in the one trial that looked in these in detail. There was heterogeneity of the effect on serum albumin in two trials. Serum PTH fell significantly in the two trials that estimated this, there was no significant effect on calcium or phosphate though both fell after correction. Complex bone markers were assessed in one study, with some evidence for a reduction in bone turnover in those with initial high bone turnover and an increase in low turnover patients. The studies were underpowered to assess clinical outcomes, in one study there was some evidence for a reduction in hospitalisation after correction.
Comment: The quality of evidence is downgraded by study quality (several limitations), by indirectness (only laboratory outcomes assessed), and by imprecise results (limited study size).
Primary/Secondary Keywords