What is the treatment for chronic metabolic acidosis in patients with chronic kidney disease (CKD)?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Alkali treatment is suggested when the serum bicarbonate concentration falls below 22 mEq/L, as treatment may decrease muscle wasting, improve bone disease, and slow the progression of CKD. [18] In patients with stages 3b and 4 CKD, treatment of metabolic acidosis with sodium bicarbonate has also been shown to significantly improve vascular endothelial function. [19] The target serum bicarbonate concentration is unclear, however; concentrations above 24 mEq/L have been tentatively linked with worsening of cardiovascular disease, which complicates treatment decisions. [20]

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