Journal Article

Metabolic acidosis and kidney disease: does bicarbonate therapy slow the progression of CKD?

Csaba P. Kovesdy

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 8, pages 3056-3062
Published in print August 2012 | ISSN: 0931-0509
Published online August 2012 | e-ISSN: 1460-2385 | DOI:
Metabolic acidosis and kidney disease: does bicarbonate therapy slow the progression of CKD?

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Metabolic acidosis is a common complication associated with progressive loss of kidney function. The diminishing ability of the kidneys to maintain acid–base homeostasis results in acid accumulation, leading to various complications such as impairment in nutritional status, worsened uremic bone disease and an association with increased mortality. In addition to these adverse effects which are related to acid retention, metabolic acidosis may also cause kidney damage, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid–base homeostasis in the face of decreasing kidney function. Recent clinical trials have suggested that correction or prevention of metabolic acidosis by alkali administration is able to attenuate kidney damage and to slow progression of chronic kidney disease (CKD), and may hence offer an effective, safe and affordable renoprotective strategy. We review the physiology and pathophysiology of acid–base homeostasis in CKD, the mechanisms whereby metabolic acidosis may be deleterious to kidney function, and the results of clinical trials suggesting a benefit of alkali therapy, with special attention to details related to the practical implementation of the results of these trials.

Keywords: bicarbonate; chronic kidney disease; metabolic acidosis; therapy

Journal Article.  4040 words.  Illustrated.

Subjects: Nephrology

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