Metabolic Acidosis in CKD: Core Curriculum 2019

Kalani L. Raphael

Research output: Contribution to journalReview articlepeer-review

42 Scopus citations


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 languageEnglish (US)
Pages (from-to)263-275
Number of pages13
JournalAmerican Journal of Kidney Diseases
Issue number2
StatePublished - Aug 2019
Externally publishedYes


  • 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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