Investigations of the Optimum Serum Bicarbonate Level in Renal Disease.

Diabetic chronic kidney disease (CKD) is a common problem in Veterans and progresses to
end-stage renal disease in many people. It is important to identify treatment strategies that
will help prevent the progression of CKD to overt kidney failure. The purpose of this study
is to see if sodium bicarbonate reduces urinary markers of kidney damage in Veterans with
diabetic CKD and normal serum bicarbonate levels.

Inclusion Criteria:

- Veteran

- Age older than 18 years

- Diabetes mellitus

- Serum bicarbonate 22 - 28 mmol/L on the most recent measurement within the past six
months

- Stage 2, 3, or 4 CKD (defined as eGFR 15 - 89 ml/min/1.73m2 using the CKD-EPI
equation)

- Urinary albumin:creatinine ratio > 30 mg/gm on the most recent sample within the past
12 months.

Exclusion Criteria:

- Lean body weight > 100 kg

- Use of oral medications typically prescribed to raise low serum bicarbonate levels
(i.e. sodium bicarbonate, sodium citrate, potassium citrate).

- Serum potassium < 3.5 meq/L at enrollment visit

- Use of 5 or more antihypertensive agents, regardless of the indications of each agent

- Systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg at the
enrollment or baseline visit

- Diagnosis of congestive heart failure with current, active Class III or IV New York
Heart Association symptoms.

- Significant fluid overload such that it is unsafe in the opinion of the PI for the
patient to participate in the trial

- chronic gastrointestinal disorder or any other factors judged to be likely to limit
adherence to interventions (i.e. alcoholism, a history of missing clinic visits)

- Chronic immunosuppressive therapy for transplanted organs or other indications

- Individuals who are currently a member of a vulnerable population (I.e. incarcerated,
pregnant).

11.Currently participating in another interventional research study