Sodium Bicarbonate & Kidney Disease

In our previous article, we explained why the popular health trend of consuming baking soda drinks to “detoxify” kidneys is unnecessary & potentially dangerous. Baking Soda is the store-bought, non-pharmaceutical grade version of the chemical compound called Sodium Bicarbonate which, interestingly serves an important role in treating kidney disease.

Now it is natural for all members with kidney disease and their caregivers to wonder why kidney patients are put on tablets of Sodium Bicarbonate despite the purported risks highlighted before.


Wouldn’t it burden already unwell kidneys this time?

That’s a valid question and this is where the classic case of “poison turning into medicine” comes into play. In a complete 180-degree twist, Sodium Bicarbonate assumes the role of a therapeutic messiah in CKD patients.

Sodium Bicarbonate Kidney


So How does that work? Read on to understand.



Sodium bicarbonate is an alkaline substance. It helps curb the acidity of any solution including blood.

Human cells require extremely strict control over how acidic or alkaline their “working environment” or in other words, the blood around them is. And this can vary from organ-to-organ. Any mild deviation in their favourable pH range can potentially trigger malfunction of an entire organ.

Our previous article highlighted that among many other functions, kidneys serve as very efficient “pH regulation managers” in good health. And they are pretty-self-sufficient in this regard.

Taking regular doses of Sodium Bicarbonate in the form of Baking Soda drinks in a bid to “detoxify our healthy kidneys” tends to make our blood alkaline. Unless otherwise there is a real clinical need for tweaking the blood pH, consuming baking soda drinks is:

! Sodium Bicarbonate KidneyUnnecessary

! Sodium Bicarbonate KidneyBears NO evidence in favour of “preventing” kidney disease

! Sodium Bicarbonate KidneyRather burdensome for our already busy kidneys

! Sodium Bicarbonate KidneyPotentially dangerous if you tend to go overboard with “detox drinking”



Just like excessive alkaline blood, a build-up of too many acids in blood has its dangers, kidney damage being one of them. Normally, kidneys work tirelessly to remove excess acids or alkalis in blood via Urine. This is how they “balance-out” the pH levels of the blood.

However, in cases where kidney disease has already set-in, it is the very alkaline nature of Sodium Bicarbonate that comes to the rescue.

Sodium Bicarbonate Kidney In Chronic Kidney Disease (CKD):

In Chronic Kidney Disease irrespective of the root cause, the delicate filters and the tiny tube systems within each kidney filtration unit (nephron) get irreversibly damaged & scarred. As a result, kidneys turn pale and shrink down in size. This is called “Fibrosis” (pronounced as “faaib-row-sis”). Image below for reference:

Sodium Bicarbonate Kidney Fibrosis

In normal health, it is these tiny filters and tube systems of the nephron that allow for removing excess blood acids and regulate blood pH for normal functioning of the human body. In a nutshell, CKD turns out to be a major blow to the pH regulation capacity of our kidneys. Our blood angrily responds by constantly turning acidic. The fancy term for this condition is “Metabolic Acidosis in CKD”.

With excessively acidic blood, cells in different organs begin to go haywire. Unwell cells within the kidney also get more sick, more rapidly with unfriendly acidic blood around them. This is the stage in CKD when we need to prescribe alkaline Sodium Bicarbonate to patients. Being an alkaline substance, it helps to “cancel out” the excess acidity of the blood due to unwell kidneys. This helps to restore close to normal blood pH when taken in doses as prescribed by your consulting doctor.

Unless the patient is too unwell, these are usually in the form of tablets of 500 mg strength to be taken once-thrice daily depending on how grave the situation is. In patients who cannot take the medicine by mouth, the medical care team may use FDA-approved Sodium Bicarbonate injections/infusions pushed directly into the bloodstream.

Sodium Bicarbonate Kidney In Kidney Stones

The use of Sodium Bicarbonate in certain types of Kidney Stones holds a similar rationale as its use in Chronic Kidney Disease. The role is to slow down the progression of the condition.

Kidney stones are basically those “moody” minerals from the blood such as calcium, magnesium and ammonium, phosphate, metabolites like uric acid or certain amino acids such as Cystine that “refuse to go-with-the-flow” once within the kidney just because their “work environment” (blood) is not up to the mark. Say for instance the blood is too acidic & dehydrated. As a mark of protest, these minerals start depositing along the bends of the tiny twisted tubes of kidney filters. With time, these deposits grow to form solid kidney stones.

Sodium Bicarbonate Kidney Stones

This wouldn’t have been much of a problem if it were quiet. Only, it isn’t. The pain of passing a kidney stone is one of the most excruciating ones among those documented in medicine! Besides, if allowed to grow unchecked, stones could completely block urine from flowing out of the kidney and potentially cause kidney damage. So, it is imperative to halt the growth of kidney stones altogether.

To achieve this, the treatment protocol for kidney stones involves adding an alkaline substance to fight-off “stone-favouring”, high blood acidity. This is where a prescription of Sodium Bicarbonate or other alkalinizing agents for kidney stones comes in.

Reducing blood acidity would convince the “moody” minerals in the urine to stop depositing any further. In some cases, it can dissolve tiny stones to pass in the urine with as less pain as is possible.


The desire for faster resolution of kidney stones can lure patients to go overboard with taking alkaline substances. However, patients must limit their Sodium Bicarbonate dosing to prescribed quantities only. This is to prevent the blood from turning too alkaline – something which again has serious health consequences.




Sodium Bicarbonate Kidney

Now some of you might be wondering why, if Baking Soda is Sodium Bicarbonate, why should you have to rely on the more expensive sodium bicarbonate tablets from the pharmacy? Couldn’t you just take a spoonful of baking soda every day instead?

Preferably not. And this is why.


FDA approved for consumption & home use, non-pharmaceutical/non-clinical purposes only.FDA-approved for Clinical / Pharmaceutical purposes.
The quality control during manufacturing meets criteria for food-grade safety standards. These are relatively less stringent than for medicines & medical devices.Quality Control standards during manufacturing this version are extremely stringent.
Safety tests for Food-grade baking soda does NOT include any clinical trials on kidney patients.Approved for marketing and sale of pharmaceutical-grade Sodium Bicarbonate to kidney patients only after intensive clinical trials for efficacy & safety.
The dose is highly uncontrolled & unregulated if left to patients hence prone to adverse effectsAvailable in pre-packaged quantities made as per standard clinical dosing, for instance, 500 mg tablets or 0.9 mEq/L injections. This reduces the chances of over-dosing.


Is there any Research Evidence in place?

Interestingly, there is a Clinical Trial conducted in 2009 to study the efficacy of Baking Soda on delaying kidney failure. The study favoured the use of baking soda as a possible, pocket-friendly option to correct acidosis in CKD patients. However, domain experts criticised this conclusion citing:

Red tick Sodium Bicarbonate Kidney Small study size (only 134 candidates) with the study authors themselves calling for validation of these results with larger, multicenter trials.

Red tick Sodium Bicarbonate Kidney Lack of “blinding” thus a strong possibility of biased results.

Red tick Sodium Bicarbonate Kidney The fact that patient supervision during the trial ensured that they received the exact dosage of baking soda throughout the study. However, in real-life scenarios, there were high chances of over or under-dosing in unsupervised CKD patients.

Red tick Sodium Bicarbonate Kidney Normal treatment protocol for CKD includes pharmaceutical-grade Sodium Bicarbonate tablets/injections pre-packaged in standard doses anyway.

Basically, the study looked into an inexpensive method to treat CKD patients. However, the study authors have themselves called for validation of their results by holding double-blinded, multi-centre trials on a larger scale. In addition, the contradictions/concerns spelled above have perhaps prevented Baking Soda from replacing Pharmaceutical-grade Sodium Bicarbonate in the standard treatment protocol for CKD till date. 



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