Acidosis and progression of chronic kidney disease.
OBJECTIVE
Chronic kidney disease progressively impairs the ability of kidneys to excrete hydrogen ions owing to the reduced capacity of the kidney to synthesize ammonia resulting in metabolic acidosis. There is good experimental evidence that metabolic acidosis contributes to protein energy wasting disorder and progression of chronic kidney disease (CKD). However, there was a lack of robust clinical evidence to support these experimental observations.


RESULTS
Three recent publications have confirmed the experimental evidence and the only randomized controlled study of its kind has suggested that the correction of acidosis by sodium bicarbonate in patients with advanced CKD is associated with attenuation of the rate of decline of renal function, reduction in the incidence of end stage renal disease and improvement of nutritional parameters.


CONCLUSIONS
In light of these recent studies, it appears that this cheap and simple strategy, which is in line with current renal recommendations, has the potential of translating into significant economic, quality of life and clinical outcome benefits in an expanding pool of patients with CKD.
Barts and the London NHS Trust and William Harvey Research Institute, London, UK. m.m.yaqoob@qmul.ac.uk
Muhammad M
MM
Yaqoob
D000138:Acidosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D000818:Animals; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications*