What issues may arise from the negative effects of metabolic acidosis in cases of chronic kidney disease (CKD)?

Updated: Jul 21, 2021
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Metabolic acidosis has been shown to have deleterious effects on protein balance, leading to the following:

  • Negative nitrogen balance
  • Increased protein degradation
  • Increased essential amino acid oxidation
  • Reduced albumin synthesis
  • Lack of adaptation to a low-protein diet

Hence, metabolic acidosis is associated with protein-energy malnutrition, loss of lean body mass, and muscle weakness. The mechanism for reducing protein may include effects on adenosine triphosphate (ATP)–dependent ubiquitin proteasomes and increased activity of branched-chain keto acid dehydrogenases.

Metabolic acidosis also leads to an increase in fibrosis and rapid progression of kidney disease, by causing an increase in ammoniagenesis to enhance hydrogen excretion.

In addition, metabolic acidosis is a factor in the development of renal osteodystrophy, because bone acts as a buffer for excess acid, with resultant loss of mineral. Acidosis may interfere with vitamin D metabolism, and patients who are persistently more acidotic are more likely to have osteomalacia or low-turnover bone disease.

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