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Management of the Metabolic Acidosis of Chronic Kidney Disease.
Adv Chronic Kidney Dis. 2017 09; 24(5):298-304.AC

Abstract

Subjects with CKD and reduced glomerular filtration rate are at risk for chronic metabolic acidosis, and CKD is its most common cause. Untreated metabolic acidosis, even in its mildest forms, is associated with increased mortality and morbidity and should therefore be treated. If reduced glomerular filtration rate or the tubule abnormality causing chronic metabolic acidosis cannot be corrected, it is typically treated with dietary acid (H+) reduction using Na+-based alkali, usually NaHCO3. Dietary H+ reduction can also be accomplished with the addition of base-producing foods such as fruits and vegetables and limiting intake of H+-producing foods like animal-sourced protein. The optimal dose of Na+-based alkali that prevents the untoward effects of metabolic acidosis while minimizing adverse effects and the appropriate combination of this traditional therapy with dietary strategies remain to be determined by ongoing studies. Recent emerging evidence supports a phenomenon of H+ retention, which precedes the development of metabolic acidosis by plasma acid-base parameters, but further studies will be needed to determine how best to identify patients with this phenomenon and whether they too should be treated with dietary H+ reduction.

Authors+Show Affiliations

Baylor Scott and White Health Department of Internal Medicine, Temple, TX; Texas A&M Health Science Center College of Medicine, Temple, TX; Baylor Scott and White Health Department of Internal Medicine, Dallas, TX; and Texas A&M Health Science Center College of Medicine, Dallas, TX.Baylor Scott and White Health Department of Internal Medicine, Temple, TX; Texas A&M Health Science Center College of Medicine, Temple, TX; Baylor Scott and White Health Department of Internal Medicine, Dallas, TX; and Texas A&M Health Science Center College of Medicine, Dallas, TX. Electronic address: donald.wesson@BSWHealth.org.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29031356

Citation

Goraya, Nimrit, and Donald E. Wesson. "Management of the Metabolic Acidosis of Chronic Kidney Disease." Advances in Chronic Kidney Disease, vol. 24, no. 5, 2017, pp. 298-304.
Goraya N, Wesson DE. Management of the Metabolic Acidosis of Chronic Kidney Disease. Adv Chronic Kidney Dis. 2017;24(5):298-304.
Goraya, N., & Wesson, D. E. (2017). Management of the Metabolic Acidosis of Chronic Kidney Disease. Advances in Chronic Kidney Disease, 24(5), 298-304. https://doi.org/10.1053/j.ackd.2017.06.006
Goraya N, Wesson DE. Management of the Metabolic Acidosis of Chronic Kidney Disease. Adv Chronic Kidney Dis. 2017;24(5):298-304. PubMed PMID: 29031356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of the Metabolic Acidosis of Chronic Kidney Disease. AU - Goraya,Nimrit, AU - Wesson,Donald E, PY - 2017/05/05/received PY - 2017/06/27/accepted PY - 2017/10/17/entrez PY - 2017/10/17/pubmed PY - 2018/6/16/medline KW - Acid KW - Alkali KW - Bicarbonate KW - Chronic kidney disease KW - Diet SP - 298 EP - 304 JF - Advances in chronic kidney disease JO - Adv Chronic Kidney Dis VL - 24 IS - 5 N2 - Subjects with CKD and reduced glomerular filtration rate are at risk for chronic metabolic acidosis, and CKD is its most common cause. Untreated metabolic acidosis, even in its mildest forms, is associated with increased mortality and morbidity and should therefore be treated. If reduced glomerular filtration rate or the tubule abnormality causing chronic metabolic acidosis cannot be corrected, it is typically treated with dietary acid (H+) reduction using Na+-based alkali, usually NaHCO3. Dietary H+ reduction can also be accomplished with the addition of base-producing foods such as fruits and vegetables and limiting intake of H+-producing foods like animal-sourced protein. The optimal dose of Na+-based alkali that prevents the untoward effects of metabolic acidosis while minimizing adverse effects and the appropriate combination of this traditional therapy with dietary strategies remain to be determined by ongoing studies. Recent emerging evidence supports a phenomenon of H+ retention, which precedes the development of metabolic acidosis by plasma acid-base parameters, but further studies will be needed to determine how best to identify patients with this phenomenon and whether they too should be treated with dietary H+ reduction. SN - 1548-5609 UR - https://www.unboundmedicine.com/medline/citation/29031356/Management_of_the_Metabolic_Acidosis_of_Chronic_Kidney_Disease_ DB - PRIME DP - Unbound Medicine ER -