Recent Evidence on the Effect of Treatment of Metabolic Acid on the Progression of Kidney Disease

Sebastian Hultin; David W. Johnson; Sunil V. Badve


Curr Opin Nephrol Hypertens. 2021;30(5):467-473. 

In This Article


The emerging evidence shows that correction of metabolic acidosis with bicarbonate may slow the progression of kidney disease. However, high-quality trial-based evidence is still lacking. RCTs failing to demonstrate a separation of serum bicarbonate between intervention and control groups have also failed to show kidney benefit.[21,22] In trials where separation was achieved, acid-lowering therapy abrogated kidney function decline and progression to kidney failure.[17,31–34] Despite trials not demonstrating worsening blood pressure, hospitalizations for congestive cardiac failure or peripheral oedema with sodium bicarbonate therapy, other reported side effects include gastrointestinal side effects and pill burden have been commonly reported. Whilst institution of acid-lowering interventions in CKD patients with acidosis may be a reasonable consideration despite the low certainty of evidence, adequately powered trials are required to evaluate the efficacy and safety of correction of metabolic acidosis to delay kidney disease progression.