Metabolic Acidosis in CKD: Core Curriculum 2019

Kalani L. Raphael

doi:10.1053/j.ajkd.2019.01.036

Metabolic Acidosis in CKD: Core Curriculum 2019

Kalani L. Raphael

Research output: Contribution to journal › Review article › peer-review

42 Scopus citations

Abstract

Maintenance of normal acid-base homeostasis is one of the most important kidney functions. In chronic kidney disease, the capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid is impaired, resulting in acid retention and metabolic acidosis. The prevalence of metabolic acidosis increases with declining glomerular filtration rate. Metabolic acidosis is associated with several clinically important complications, including chronic kidney disease progression, bone demineralization, skeletal muscle catabolism, and mortality. To mitigate these adverse consequences, clinical practice guidelines suggest treating metabolic acidosis with oral alkali in patients with chronic kidney disease. However, large clinical trials to determine the efficacy and safety of correcting metabolic acidosis with oral alkali in patients with chronic kidney disease have yet to be conducted. In this Core Curriculum article, established and emerging concepts regarding kidney acid-base regulation and the pathogenesis, risk factors, diagnosis, and management of metabolic acidosis in chronic kidney disease are discussed.

Original language	English (US)
Pages (from-to)	263-275
Number of pages	13
Journal	American Journal of Kidney Diseases
Volume	74
Issue number	2
DOIs	https://doi.org/10.1053/j.ajkd.2019.01.036
State	Published - Aug 2019
Externally published	Yes

Keywords

CKD progression
Metabolic acidosis
acid excretion
acid load
alkali therapy
chronic kidney disease (CKD)
review
sodium bicarbonate
tCO

ASJC Scopus subject areas

Nephrology

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10.1053/j.ajkd.2019.01.036

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title = "Metabolic Acidosis in CKD: Core Curriculum 2019",

abstract = "Maintenance of normal acid-base homeostasis is one of the most important kidney functions. In chronic kidney disease, the capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid is impaired, resulting in acid retention and metabolic acidosis. The prevalence of metabolic acidosis increases with declining glomerular filtration rate. Metabolic acidosis is associated with several clinically important complications, including chronic kidney disease progression, bone demineralization, skeletal muscle catabolism, and mortality. To mitigate these adverse consequences, clinical practice guidelines suggest treating metabolic acidosis with oral alkali in patients with chronic kidney disease. However, large clinical trials to determine the efficacy and safety of correcting metabolic acidosis with oral alkali in patients with chronic kidney disease have yet to be conducted. In this Core Curriculum article, established and emerging concepts regarding kidney acid-base regulation and the pathogenesis, risk factors, diagnosis, and management of metabolic acidosis in chronic kidney disease are discussed.",

keywords = "CKD progression, Metabolic acidosis, acid excretion, acid load, alkali therapy, chronic kidney disease (CKD), review, sodium bicarbonate, tCO",

author = "Raphael, {Kalani L.}",

note = "Funding Information: Dr Raphael receives support from VA Merit Award I01-CX001695 from the US Department of Veterans Affairs Clinical Sciences Research and Development Service and the National Institute of Diabetes and Digestive and Kidney Diseases U01DK0099933 Research Project Cooperative Agreement. Funding Information: Dr Raphael receives support from VA Merit Award I01-CX001695 from the US Department of Veterans Affairs Clinical Sciences Research and Development Service and the National Institute of Diabetes and Digestive and Kidney Diseases U01DK0099933 Research Project Cooperative Agreement. Dr Raphael received a 1-time consulting fee from Tricida, Inc. Received July 11, 2018, in response to an invitation from the journal. Evaluated by 2 external peer reviewers and a member of the Feature Advisory Board, with direct editorial input from the Feature Editor and a Deputy Editor. Accepted in revised form January 23, 2019. Publisher Copyright: {\textcopyright} 2019 National Kidney Foundation, Inc.",

year = "2019",

month = aug,

doi = "10.1053/j.ajkd.2019.01.036",

language = "English (US)",

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PY - 2019/8

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N2 - Maintenance of normal acid-base homeostasis is one of the most important kidney functions. In chronic kidney disease, the capacity of the kidneys to excrete the daily acid load as ammonium and titratable acid is impaired, resulting in acid retention and metabolic acidosis. The prevalence of metabolic acidosis increases with declining glomerular filtration rate. Metabolic acidosis is associated with several clinically important complications, including chronic kidney disease progression, bone demineralization, skeletal muscle catabolism, and mortality. To mitigate these adverse consequences, clinical practice guidelines suggest treating metabolic acidosis with oral alkali in patients with chronic kidney disease. However, large clinical trials to determine the efficacy and safety of correcting metabolic acidosis with oral alkali in patients with chronic kidney disease have yet to be conducted. In this Core Curriculum article, established and emerging concepts regarding kidney acid-base regulation and the pathogenesis, risk factors, diagnosis, and management of metabolic acidosis in chronic kidney disease are discussed.

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KW - Metabolic acidosis

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KW - sodium bicarbonate

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Metabolic Acidosis in CKD: Core Curriculum 2019

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