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In Reply: To Dr Shavit and colleagues, we state that our primary end point was defined by percent change in serum creatinine. Percent change in GFR was a secondary observation. As noted in our methods section, we estimated the primary and secondary end points using the modified rather than the original Levey formula.¹ The Modification of Diet in Renal Disease Study Group estimates GFR by multiplying: 186 x creatinine^–1.154 x age^–0.203. If the patient is African American, the product is multiplied by 1.21. If the patient is female, the product is multiplied by 0.742. If the patient is both African American and female, the product is multiplied by 1.21 and 0.742. This formula does not use serum albumin or BUN to calculate GFR. Thus, better expansion of extracellular volume by NaHCO₃ with subsequent dilution of serum albumin or BUN can not account for our findings. Moreover, previous investigators have . . . [Full Text of this Article]

W. Patrick Burgess, MD, PhD; Gregory J. Merten, MD; Thomas P. Kennedy, MD, MPH
tkennedy@carolinas.org
Department of Internal Medicine
Carolinas Medical Center
Charlotte, Nc

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