Management of Metabolic Acidosis in CKD: Core Curriculum 2019

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.