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World J Nephrol. Oct 10, 2018; 7(6): 117-122
Published online Oct 10, 2018. doi: 10.5527/wjn.v7.i6.117
Oral alkali therapy and the management of metabolic acidosis of chronic kidney disease: A narrative literature review
Adeel Rafi Ahmed, David Lappin
Adeel Rafi Ahmed, David Lappin, Department of Nephrology, University Hospital Galway, Galway H91YR1, Ireland
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adeel Rafi Ahmed, MBChB, MRCP, Staff Physician, Department of Nephrology, University Hospital Galway, Newcastle Road, Galway H91YR1, Ireland. adeel.r.ahmed@gmail.com
Telephone: +353-86-2350526
Received: May 7, 2018
Peer-review started: May 7, 2018
First decision: May 25, 2018
Revised: July 14, 2018
Accepted: August 30, 2018
Article in press: August 30, 2018
Published online: October 10, 2018
Processing time: 157 Days and 8.2 Hours
Abstract

Chronic metabolic acidosis is a common complication seen in advanced chronic kidney disease (CKD). There is currently no consensus on its management in the Republic of Ireland. Recent trials have suggested that appropriate active management of metabolic acidosis through oral alkali therapy and modified diet can have a deterring impact on CKD progression. The potential benefits of treatment include preservation of bone health and improvement in muscle function; however, present data is limited. This review highlights the current evidence, available primarily from randomised control trials (RCTs) over the last decade, in managing the metabolic acidosis of CKD and outlines ongoing RCTs that are promising. An economic perspective is also briefly discussed to support decision-making.

Keywords: Chronic metabolic acidosis; Chronic kidney disease; Oral sodium bicarbonate; Oral alkali therapy; Health economics; Serum bicarbonate

Core tip: Chronic metabolic acidosis contributes to the progression of chronic kidney disease (CKD). We summarise and analyse current evidence regarding the management of the metabolic acidosis of CKD, as well as the potential benefits and adverse effects. We also offer novel therapeutic guidelines for clinicians, which include the most evidence-based range to maintain serum bicarbonate in the CKD patient population.