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Chronic Kidney DiseasesPhase 2Senergy-CKDNCT04984226

Sodium Bicarbonate and Mitochondrial Energetics in Persons With CKD

A Phase 2 study testing Sodium bicarbonate in people with Chronic Kidney Diseases and Metabolic Acidosis, run by University of California, Davis at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Skeletal muscle metabolic health is critical for mobility and an underrecognized target of metabolic acidosis in chronic kidney disease. Impaired muscle mitochondrial metabolism underlies poor physical endurance increasing the risk of mobility disability. Read more about this study

Who is it for?
Ages 21 to 85 years
What is being tested?
Sodium bicarbonate
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
80 participants
Where
2 sitesUnited States
Study dates
8 Sep 2023to 31 Dec 2026
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Moderate-severe CKD determined by eGFR <50ml/min per 1.73m2 by CKD EPI equation on at least 2 consecutive occasions.
  • Metabolic acidosis defined as bicarbonate level<24 on two consecutive occasions. Bicarbonate level of 24 or less allowed if eGFR<=45ml/min per 1.73m2
  • Age 21 to 85 years old

Who cannot join

  • Type 1 diabetes
  • Poorly controlled diabetes (HgbA1c>10%)
  • History of persistent hyperkalemia (K>5.4)
  • History of persistent hypokalemia (K<3.3)
  • Uncontrolled blood pressure (>170/100)
  • Chronic treatment with renal replacement therapy
Show all 28Show fewer
  • History of aortic dissection or severe valvular heart disease
  • Exercise induced angina
  • Uncontrolled cardiac dysrhythmia
  • Oxygen dependent chronic obstructive pulmonary disease (COPD)
  • Symptomatic claudication
  • End stage liver disease
  • Mobility disability defined as inability to walk without human assistance
  • Dementia or psychosis
  • Patients who cannot consent
  • Active use of intraveneous drugs
  • Non-english speaking
  • History of transplant
  • Implants that prohibit MRI measurements or trauma involving metal fragments
  • Pacemaker
  • Expectation to start dialysis during the course of study.
  • Women who are breastfeeding, pregnant, or are wanting to become pregnant
  • Any condition which in the judgement of the clinical investigator places the participant at risk from participation in the study.
  • Drugs- anticoagulants or antiplatelets:
  • Anticoagulants, any 1 (coumadin, rivaroxaban, apixaban, dabigatran, edoxaban)
  • Antiplatelets, any 2 (aspirin, cilostazol, clopidogrel, dipyridamole, prasugrel, ticragrelor, ticlopidine, vorapaxar)
  • Platelet count <100,000
  • International normalized ratio (INR)>1.4

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Baback Roshanravan, MD contact

530-754-0893

broshanr@ucdavis.edu

United States2 sites, 2 recruiting
  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

    Delia Woods, RN, delia.woods@vumc.org

    Jorge Gamboa, MD PhD

    Not yet recruiting
  • University of California Davis Health

    Sacramento, California, 95817

    Amanda Lopez, 916-734-0898, aflopez@ucdavis.edu

    Erica Goude, (916) 734-0384, emgoude@ucdavis.edu

    Recruiting

Other trials in United States

About this study

Official title: Randomized Cross-over Trial of Sodium Bicarbonate on Muscle Mitochondrial Energetics and Physical Endurance in Chronic Kidney Disease and Metabolic Acidosis

Skeletal muscle metabolic health is critical for mobility and an underrecognized target of metabolic acidosis in chronic kidney disease. Impaired muscle mitochondrial metabolism underlies poor physical endurance increasing the risk of mobility disability. The proposed project will use precise in vivo tools to study the pathophysiology of poor physical endurance in a clinical trial treating metabolic acidosis among persons living with chronic kidney disease.

Read the detailed description

Chronic kidney disease (CKD) is highly prevalent affecting 14% of the U.S. population leading to substantial morbidity and reduced quality of life. Older adults with CKD identify maintenance of functional independence as their top priority. Skeletal muscle health is critical for mobility and an underrecognized target of metabolic acidosis (MA) and protein energy wasting in CKD. Skeletal muscle endurance provides a window into muscle metabolic health and muscle quality. Muscle mitochondrial metabolism is central to muscle and walking endurance providing energy from carbohydrates and fats to power repeated muscle contraction. Investigators showed metabolic acidosis and muscle adiposity as the major determinants of muscle mitochondrial function.

Metabolic acidosis (MA) is long believed to be the main mechanism leading to skeletal muscle wasting and peripheral insulin resistance in CKD. Skeletal muscle mitochondrial metabolism is considered a principal determinant of peripheral insulin sensitivity and muscle quality, but little is known of the impact of MA on muscle mitochondrial function. Muscle mitochondrial dysfunction leads to defective lipid metabolism augmenting adiposity and lipotoxic intermediates resulting in insulin resistance, low endurance, and muscle atrophy. Using in vivo 31Phosphorus Magnetic Resonance Spectroscopy (31P MRS) investigators showed that the presence and severity of CKD is strongly associated with impaired muscle mitochondrial capacity to generate ATP translating into poor walking endurance. Investigators also showed MA and muscle adiposity are the major determinants of muscle mitochondrial function. Despite the importance of mitochondrial function to muscle health, it is unknown if treatment of MA benefits muscle mitochondrial function, adiposity or endurance in CKD.

The proposed project will use precise, in vivo 31P MRS and gold-standard testing of peripheral insulin sensitivity by hyperinsulinemic euglycemic clamp to probe the pathophysiology of MA and low endurance in a clinical trial of alkali therapy in CKD and MA. We will compare sodium bicarbonate to placebo in a multicenter randomized, cross-over trial design in 80 persons with moderate-severe CKD and MA. First, the efficacy of 4-months of alkali therapy will be tested comparing sodium bicarbonate versus placebo on muscle metabolic health in a randomized crossover trial in MA. Second, we will test the efficacy of 4-months of alkali therapy comparing sodium bicarbonate versus placebo on improving physical endurance in MA. The rationale is that identification of therapeutic targets for low physical endurance will inform the development of pharmacologic interventions. Long term, it is expected that strategies treating MA will improve exercise tolerance enabling effective engagement in lifestyle interventions improving quality of life in CKD.

Being tested
Sodium bicarbonate, placebo
Keywords
Metabolic acidosis, Chronic kidney disease, Insulin resistance
Medical subject headings
Renal Insufficiency, Chronic, Acidosis, Fatigue, Insulin Resistance, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Sodium bicarbonateDrug

    Sodium bicarbonate will be dosed at 0.8meq per kilogram of ideal body weight daily (1meq is approximately 84mg). We will use the Devine formula to determine ideal body weight. Investigational Drug Services at both UC Davis and Vanderbilt will compound the sodium bicarbonate. Sodium bicarbonate 650 mg tablets will be over-encapsulated and matching placebo capsules will be prepared. Participants will be limited to a maximum of 9 capsules daily (maximum dose = 5850mg of sodium bicarbonate). Capsules will be dispensed to patients in two separate 8-week allotments. The dose will be rounded to the nearest whole capsule and depending on participant preference may be divided into portions taken twice or thrice daily. Given the high probability of interruption in sodium bicarbonate supply and availability, we may need to change brands of sodium bicarbonate intermittently.

  • placeboDrug

    The placebo and filler for for sodium bicarbonate capsules will be comprised of microcrystalline cellulose. Capsule appearance for control and sodium bicarbonate will be the same.

Study groups in NCT04984226
Study groupRoleWhat they receive
Sodium bicarbonate 16 weeksExperimentalSodium bicarbonate will be dosed at 0.8meq per kilogram of ideal body weight daily (1meq is approximately 84mg). We will use the Devine formula to determine ideal body weight. Investigational Drug Services at both UC Davis and Vanderbilt will compound the sodium bicarbonate. Sodium bicarbonate 650 mg tablets will be over-encapsulated and matching placebo capsules will be prepared. Participants will be limited to a maximum of 9 capsules daily (maximum dose = 5850mg of sodium bicarbonate). Capsules will be dispensed to patients in two separate 8-week allotments. The dose will be rounded to the nearest whole capsule and depending on participant preference may be divided into portions taken twice or thrice daily. Given the high probability of interruption in sodium bicarbonate supply and availability, we may need to change brands of sodium bicarbonate intermittently.
Receives: Drug: Sodium bicarbonate
placebo 16 weeksPlacebo comparatorMicrocrystalline cellulose
Receives: Drug: placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. muscle mitochondrial oxidative capacity by 31P MRS

    We will use 31P MRS to evaluate the concentration of phospho-creatine (PCr) and other phosphate-energy carrier molecules in limb muscles. After one minute of basal resting measurements, patients will be asked to perform two knee extensions every second against ankle weights 5-10% of the maximal voluntary contraction. The exercise protocol will last 60-90 seconds (a total of 60 knee extensions) followed by 6 minutes of rest. The intensity of the exercise decreases phosphocreatine (PCr) levels with minimal change in muscle pH. Spectra analysis was performed with AMARES from the jMRUI software package. Spectra are used to calculate the relative concentrations of inorganic phosphate (Pi), PCr, and ATP. PCr recovery will be measured through 6min of rest and fit with a monoexponential equation.

    Measured: 16 weeks

  2. Insulin sensitivity (SI) by insulin clamp

    Primary endpoint for the hyperinsulinemic euglycemic clamp testing will be insulin sensitivity defined as (glucose disposal rate - concentration of infused glucose)/(insulin concentration at steady state - fasting insulin concentration). Units are mg/min per microunit per milliliter.

    Measured: 16 weeks

  3. total work performed on cycle ergometry VO2

    Total work will be obtained by cycle ergometry using standard protocol measuring oxygen uptake starting at 0 watts (W) at 60 rotations per minute (rpm) increasing by 25W every 2 minutes until volitional exhaustion adapting a prior protocol used in CKD patients. The primary measure will be total work completed (Joules).

    Measured: 16 weeks

  4. muscle work efficiency cycle ergometry

    joules/ml Oxygen(VO2 peak)

    Measured: 16 weeks

  5. Walking endurance by 6-minute walk

    Meters

    Measured: 16 weeks

  6. FACIT-F Fatigue (PRO)

    score on FACIT-F questionnaire

    Measured: 16 weeks

Secondary outcomes (3)
  1. Intermuscular fat by MRI

    Percent intermuscular fat.

    Measured: 16 weeks

  2. 30 second sit to stand test

    number of times patient can get up from sitting position over 30 seconds

    Measured: 16 weeks

  3. PROMIS Fatigue (PRO)

    score on NIH PROMIS Fatigue questionnaire

    Measured: 16 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Jul 2021
  2. Study start8 Sep 2023
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Crossover
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04984226
Sponsor's protocol ID
1785131
Other IDs
5R01DK129793
Acronym
Senergy-CKD
Status last verified
May 2026
First submitted
8 Jul 2021
Last updated
6 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data will be available to other investigators on request. The requests will include a proposal outlining the research question, specific exposures, outcomes of interest and analytic plan. All requests will be reviewed by the study principal investigators and coinvestigators prior to release of data. All data will be de-identified.

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Sodium bicarbonate in people with Chronic Kidney Diseases and Metabolic Acidosis, run by University of California, Davis at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 28 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 6 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Baback Roshanravan, MD (530-754-0893, broshanr@ucdavis.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

muscle mitochondrial oxidative capacity by 31P MRS (time frame: 16 weeks). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2026.

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