Tags

Type your tag names separated by a space and hit enter

Metabolic Acidosis of CKD: An Update.
Am J Kidney Dis. 2016 Feb; 67(2):307-17.AJ

Abstract

The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to <20 to 25mL/min/1.73 m(2), although it can develop with lesser degrees of decreased kidney function. Non-anion gap acidosis, high-anion gap acidosis, or both can be found at all stages of CKD. The acidosis can be associated with muscle wasting, bone disease, hypoalbuminemia, inflammation, progression of CKD, and increased mortality. Administration of base may decrease muscle wasting, improve bone disease, and slow the progression of CKD. Base is suggested when serum bicarbonate concentration is <22 mEq/L, but the target serum bicarbonate concentration is unclear. Evidence that increments in serum bicarbonate concentration > 24 mEq/L might be associated with worsening of cardiovascular disease adds complexity to treatment decisions. Further study of the mechanisms through which metabolic acidosis contributes to the progression of CKD, as well as the pathways involved in mediating the benefits and complications of base therapy, is warranted.

Authors+Show Affiliations

Medical and Research Services, VHAGLA Healthcare System, UCLA Membrane Biology Laboratory, Los Angeles, CA; Division of Nephrology, VHAGLA Healthcare System and David Geffen School of Medicine, Los Angeles, CA. Electronic address: jkraut@ucla.edu.Department of Medicine, Division of Nephrology, St. Elizabeth's Medical Center, Boston, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: nicolaos.madias@steward.org.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Review

Language

eng

PubMed ID

26477665

Citation

Kraut, Jeffrey A., and Nicolaos E. Madias. "Metabolic Acidosis of CKD: an Update." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 67, no. 2, 2016, pp. 307-17.
Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update. Am J Kidney Dis. 2016;67(2):307-17.
Kraut, J. A., & Madias, N. E. (2016). Metabolic Acidosis of CKD: An Update. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 67(2), 307-17. https://doi.org/10.1053/j.ajkd.2015.08.028
Kraut JA, Madias NE. Metabolic Acidosis of CKD: an Update. Am J Kidney Dis. 2016;67(2):307-17. PubMed PMID: 26477665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metabolic Acidosis of CKD: An Update. AU - Kraut,Jeffrey A, AU - Madias,Nicolaos E, Y1 - 2015/10/23/ PY - 2015/03/13/received PY - 2015/08/01/accepted PY - 2015/10/20/entrez PY - 2015/10/20/pubmed PY - 2016/5/27/medline KW - Metabolic acidosis KW - acid-base balance KW - base therapy KW - chronic kidney disease (CKD) KW - hypobicarbonatemia KW - positive acid balance KW - renal disease progression KW - review KW - serum bicarbonate SP - 307 EP - 17 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 67 IS - 2 N2 - The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to <20 to 25mL/min/1.73 m(2), although it can develop with lesser degrees of decreased kidney function. Non-anion gap acidosis, high-anion gap acidosis, or both can be found at all stages of CKD. The acidosis can be associated with muscle wasting, bone disease, hypoalbuminemia, inflammation, progression of CKD, and increased mortality. Administration of base may decrease muscle wasting, improve bone disease, and slow the progression of CKD. Base is suggested when serum bicarbonate concentration is <22 mEq/L, but the target serum bicarbonate concentration is unclear. Evidence that increments in serum bicarbonate concentration > 24 mEq/L might be associated with worsening of cardiovascular disease adds complexity to treatment decisions. Further study of the mechanisms through which metabolic acidosis contributes to the progression of CKD, as well as the pathways involved in mediating the benefits and complications of base therapy, is warranted. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26477665/Metabolic_Acidosis_of_CKD:_An_Update_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)01211-1 DB - PRIME DP - Unbound Medicine ER -