| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated | 
| Metabolic acidosis in chronic kidney disease |  
| Metabole acidose bij chronische nierinsufficientie |  | 
| E.1.1.1 | Medical condition in easily understood language | 
| High blood acidity in patients with chronic kidney disease |  
| verhoogde zuurgraad van het bloed bij mensen met een chronische nierziekte
 |  | 
| E.1.1.2 | Therapeutic area | Body processes [G] - Physiological processes [G07] | 
| MedDRA Classification | 
| E.1.3 | Condition being studied is a rare disease | No | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial | 
| To study if sodiumbicarbonate therapy diminishes activity of the intrarenal renin-angiotensin-system (RAS) without affecting the
 systemic RAS, i.e. the intrarenal RAS can be inhibited by oral alkali in
 CKD patients with metabolic acidosis.
 |  
| Om te bestuderen of natriumbicarbonaat de activiteit van het intrarenale renine-angiotensine-systeem vermindert, zonder het systemische RAS te
 beinvloeden. In andere woorden: het intrarenale RAS kan worden
 geremd door orale alkali in patienten met chronische nierschade en
 metabole acidose.
 |  | 
| E.2.2 | Secondary objectives of the trial | 
| - To study if sodium bicarbonate therapy in patients with metabolic acidosis due to chronic kidney disease effects kidney damage markers.
 - To study whether or not there is a difference in alteration of levels of
 RAS components in response to sodium bicarbonate therapy in patients
 with metabolic acidosis due to chronic kidney disease treated with AT-1
 receptor blockade and without.
 |  
| - te bekijken of sodiumbicarbonaat therapie in patienten met metabole acidose als gevolg van chronische nierinsufficientie nierschade-markers
 beinvloed.
 - te bestuderen of er een verschil is in verandering van RAS
 componenten na natriumbicarbonaat bij patienten met metabole acidose
 als gevolg van chronische nierinsufficientie, die behandeld worden met
 een AT-1 receptor blokker en patienten die hier niet mee behandeld
 worden
 |  | 
| E.2.3 | Trial contains a sub-study | No | 
| E.3 | Principal inclusion criteria | 
| - male or female adult (>18 years) - chronic kidney disease stage 4, i.e. eGFR (MDRD) 15-30 ml/min
 - plasma bicarbonate concentration of <24 and >15 meq/L, the latter
 because in that case it seems highly recommended to start
 sodiumbicarbonate suppletion and not to postpone this
 |  
| - volwassen man/vrouw (ouder dan 18 jaar) - chronische nierinsufficientie, stadium 4, m.a.w. eGFR (MDRD) 15-30
 ml/min
 - plasma bicarbonaat concentratie onder de 24 en boven de 15 mmol/L,
 het laatste omdat het onder de 15 aan te raden is het starten van
 natriumbicarbonaat therapie niet uit te stellen
 |  | 
| E.4 | Principal exclusion criteria | 
| - plasma bicarbonate level >24 meq/L or <15 meq/L - sodiumbicarbonate use in the 1 month preceeding the study
 - a kidney transplant in situ
 - heart failure
 - liver cirrhosis
 - resistant hypertension (blood pressure >140/90 mmHg despite the use of 3 or more different antihypertensives
 - a history of inadherence to medication
 - use of calcineurin inhibitors (these immunosuppressive drugs are
 known to induce metabolic acidosis and influence electrolytes and acidbase
 balance)
 |  
| - een plasma bicarbonaat groter dan 24mmol/L of kleiner dan 15 mmol/L
 - natriumbicarbonaat gebruik in de maand voor de studie
 - een niertransplantaat in situ
 - hartfalen
 - levercirrose
 - therapieresistente hypertensie (bloeddruk >140/90 ondanks 3 of meer verschillende antihypertensiva
 - een voorgeschiedenis van medicatieontrouw
 - gebruik van calcineurine remmers (deze immunosuppresieve middelen
 kunnen metabole acidose induceren en beinvloeden electrolyten en zuurbase
 balans)
 |  | 
| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| Study ends after 4 weeks (in which the patient recieved Sodium Bicarbonate, Sodium Chloride or none of both). Main study parameter is urinary renin levels.
 |  
| De studie stopt na 4 weken (waarin de patient Natriumbicarbonaat, Natriumchloride of geen van beide krijgt). Belangrijkste parameter is het urine-renine.
 |  | 
| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
| not applicable |  
| niet van toepassing |  | 
| E.5.2 | Secondary end point(s) | 
| not applicable |  
| niet van toepassing |  | 
| E.5.2.1 | Timepoint(s) of evaluation of this end point | 
| not applicable |  
| niet van toepassing |  | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis | No | 
| E.6.2 | Prophylaxis | No | 
| E.6.3 | Therapy | No | 
| E.6.4 | Safety | No | 
| E.6.5 | Efficacy | No | 
| E.6.6 | Pharmacokinetic | No | 
| E.6.7 | Pharmacodynamic | Yes | 
| E.6.8 | Bioequivalence | No | 
| E.6.9 | Dose response | No | 
| E.6.10 | Pharmacogenetic | No | 
| E.6.11 | Pharmacogenomic | No | 
| E.6.12 | Pharmacoeconomic | No | 
| E.6.13 | Others | No | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) | No | 
| E.7.1.1 | First administration to humans | No | 
| E.7.1.2 | Bioequivalence study | No | 
| E.7.1.3 | Other | No | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) | No | 
| E.7.3 | Therapeutic confirmatory (Phase III) | No | 
| E.7.4 | Therapeutic use (Phase IV) | Yes | 
| E.8 Design of the trial | 
| E.8.1 | Controlled | Yes | 
| E.8.1.1 | Randomised | Yes | 
| E.8.1.2 | Open | Yes | 
| E.8.1.3 | Single blind | No | 
| E.8.1.4 | Double blind | No | 
| E.8.1.5 | Parallel group | No | 
| E.8.1.6 | Cross over | No | 
| E.8.1.7 | Other | No | 
| E.8.2 | Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) | Yes | 
| E.8.2.2 | Placebo | No | 
| E.8.2.3 | Other | Yes | 
| E.8.2.3.1 | Comparator description | 
| tijds-controle |  
| time-control |  | 
| E.8.2.4 | Number of treatment arms in the trial | 3 | 
| E.8.3 | The trial involves single site in the Member State concerned | No | 
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes | 
| E.8.4.1 | Number of sites anticipated in Member State concerned | 4 | 
| E.8.5 | The trial involves multiple Member States | No | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA | No | 
| E.8.6.2 | Trial being conducted completely outside of the EEA | No | 
| E.8.7 | Trial has a data monitoring committee | No | 
| E.8.8 | Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial | 
| the last visit of the last subject undergoing the trial |  
| laatste bezoek van laatste patient |  | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 3 | 
| E.8.9.1 | In the Member State concerned months |  | 
| E.8.9.1 | In the Member State concerned days |  |