# Exploration of Oral Sodium Bicarbonate Acceptance and Adherence among Chronic Kidney Disease Patients with Metabolic Acidosis: A Multicentre Cross-Sectional Survey

## TL;DR

This study found that CKD patients with metabolic acidosis prefer sodium bicarbonate tablets over powdered solutions, leading to better adherence and acceptance.

## Contribution

The study provides new insights into patient preferences and adherence to oral sodium bicarbonate formulations in CKD patients.

## Key findings

- Tablet users had higher acceptance scores in all domains compared to powdered solution users.
- Tablet users showed significantly higher adherence (88.9%) compared to powdered solution users (70.9%).
- Self-reported adherence correlated positively with medication acceptance domains for both formulations.

## Abstract

Oral sodium bicarbonate is recommended for treating metabolic acidosis in chronic kidney disease (CKD). However, limited information exists on patient preferences between sodium bicarbonate tablets and powdered solutions. This study aimed to provide baseline data regarding the acceptance and adherence of patients with CKD to oral sodium bicarbonate therapy.

This prospective multicentre cross-sectional study was conducted across five Malaysian government hospitals involving adult patients with pre-dialysis CKD. A questionnaire assessed demographics, clinical characteristics, bicarbonate treatment, and included the Medication Acceptance Questionnaire (MAQ) (convenience, taste, appearance, efficacy, and tolerability), along with an individual adherence assessment.

Among 203 patients analysed, the median age was 60 years (interquartile range [IQR], 16 years), and the majority were at stage 5 (n = 138, 68.0%). Sodium bicarbonate acceptance scores above 70% for all MAQ domains were significantly higher among tablet users than those of the powdered solution users, who only had scores above 70% for convenience, taste and tolerability domains. Tablet users were more adherent to treatment (88.9% vs. 70.9%, p < 0.014). A positive correlation was found between self-reported adherence and all five MAQ domain scores for the oral powdered sodium bicarbonate solution (convenience: rs = 0.223, p = 0.005; taste: rs = 0.223, p = 0.005; appearance: rs = 0.161, p = 0.043; efficacy: rs = 0.247, p = 0.002; tolerability: rs = 0.279, p < 0.001). For tablet users, significant positive correlations were observed between self-reported adherence and the convenience (rs = 0.413, p = 0.005), appearance (rs = 0.449, p = 0.002), and efficacy (rs = 0.355, p = 0.017) domains.

Tablet formulation of sodium bicarbonate was associated with higher patient acceptance and adherence, potentially leading to improved long-term clinical outcomes.