To manage metabolic acidosis in CKD, which intervention is commonly used?

• A. Start dialysis
• B. Tight blood pressure control
• C. Administer sodium bicarbonate
• D. Restrict protein intake

Answer: (C)

Metabolic acidosis in CKD happens because damaged kidneys struggle to excrete acid and to regenerate bicarbonate. The most direct and commonly used intervention to correct this imbalance is administering bicarbonate. Giving sodium bicarbonate raises the serum bicarbonate level, buffers excess hydrogen ions, and helps restore a near-normal pH. This correction reduces muscle and bone catabolism driven by acidosis, improves nutrition, and can slow some downstream effects of CKD. Dialysis can also fix acidosis, but it's typically reserved for patients who already need dialysis for kidney failure or whose acidosis is not controlled with medical therapy, so it isn’t the first-line approach for managing metabolic acidosis alone. While managing blood pressure and limiting protein intake are important for overall CKD care, they don’t directly correct the acid-base disturbance like bicarbonate therapy does.