One of the key functions of the kidney is maintenance of normal acid-base homeostasis. In patients with chronic kidney disease (CKD), the capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid is compromised. The result is acid retention and metabolic acidosis.
There is an association between declining estimated glomerular filtration rate and the prevalence of metabolic acidosis. Metabolic acidosis is associated with various clinical complications, including progression of CKD, bone demineralization, skeletal muscle catabolism, and mortality. Clinical guidelines suggest treating metabolic acidosis with oral alkali in patients with CKD to mitigate those adverse consequences.
However, there are few data available on the efficacy and safety of correcting metabolic acidosis with oral alkali in that patient population. In 2019, Kalani L. Rapheal, MD, described a Core Curriculum for treating patients with CKD and metabolic acidosis in an article published in the American Journal of Kidney Diseases [2019;74(2):263-275]. The article discussed established and emerging concepts regarding regulating kidney acid-base regulation as well as the pathogenesis, risk factors, diagnosis, and management of metabolic acidosis in CKD.