In CKD, metabolic acidosis is common; what is a standard management approach?

• A. Administer bicarbonate to correct acidosis; may slow CKD progression.
• B. Dialysis is the only option always.
• C. Avoid bicarbonate; do not treat acidosis.
• D. No change in management for acidosis.

Answer: (A)

Metabolic acidosis in CKD comes from the kidneys’ reduced ability to generate bicarbonate and to excrete acid, so restoring bicarbonate and normalizing the acid–base balance is a central part of management. The standard approach is to give bicarbonate, usually as oral sodium bicarbonate, and titrate the dose to bring serum bicarbonate into the normal or near-normal range (roughly 22–24 mEq/L). Correcting acidosis not only improves pH but is also associated with slower progression of kidney disease in many patients, likely by reducing protein catabolism, bone buffering demands, and tubular injury.

Keep an eye on the sodium load because bicarbonate adds sodium, which can affect fluid status and blood pressure. Monitor electrolytes, volume status, and signs of edema, adjusting the dose as needed or considering alternatives if fluid overload becomes an issue. Dialysis isn’t the default for everyone with acidosis; it’s reserved for those with advanced CKD or refractory acidosis when medical therapy cannot maintain bicarbonate levels. Avoiding treatment of acidosis altogether can worsen bone health, muscle wasting, and overall CKD outcomes.