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Metabolic Acidosis and Progression of Chronic Kidney Disease

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Metabolic Acidosis

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Abstract

Metabolic acidosis invariably develops as chronic kidney disease (CKD) progresses. Complications of acid retention during the course of CKD include protein-energy wasting, abnormal bone-mineral metabolism, and uremic bone disease, and also an association with higher mortality. An additional adverse effect of metabolic acidosis is kidney damage. This has been described experimentally decades ago, but it has only recently surfaced as a clinically important complication which, if treated, can result in amelioration of progressive CKD. Administration of alkali represents an affordable and probably low-risk intervention in patients with kidney disease, and hence it could become a mainstay of CKD therapy. Since it is possible, and indeed likely that large clinical trials of bicarbonate supplementation will not be conducted in the near future, a uniformly sanctioned clinical indication for kidney protection may never come to fruition for this kind of intervention. Therefore, good understanding of the physiologic background, of the practical benefits, and especially of the potential risks of bicarbonate therapy is crucial for practitioners who wish to implement such therapy. We will briefly review the physiology and pathophysiology of acid–base homeostasis in CKD, emphasizing the mechanisms responsible for kidney damage, and discuss the results of clinical trials of alkali therapy, with an emphasis towards practical aspects relevant to everyday clinical practice.

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  1. Division of Nephrology, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA

    Csaba P. Kovesdy M.D.

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Correspondence to Csaba P. Kovesdy M.D. .

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  1. Baylor Scott & WhiteHealth Dept Int Med., Texas A&M Health Sci. Cent. Collg of Med, Temple, Texas, USA

    Donald E. Wesson

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Kovesdy, C.P. (2016). Metabolic Acidosis and Progression of Chronic Kidney Disease. In: E. Wesson, D. (eds) Metabolic Acidosis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3463-8_13

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