Eubicarbonatemic Hydrogen Ion Retention and CKD Progression

Abstract

Small-scale trials in patients with chronic kidney disease (CKD) 3-5 have shown that hypobicarbonatemic metabolic acidosis promotes progression of CKD. Accordingly, the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline suggests base administration to patients with CKD when serum bicarbonate concentration ([HCO 3ˉ] ) is <22 mEq/L (~15% of non--dialysis-dependent patients with CKD). However, individuals with milder CKD largely maintain serum [HCO 3ˉ] within the normal range (eubicarbonatemia) and yet can manifest hydrogen ion (H + ) retention. Limited data in eubicarbonatemic patients with CKD 2 suggest that base administration ameliorates CKD progression. Furthermore, most patients with moderate and advanced CKD maintain a normal serum [HCO 3ˉ] , and of those, the vast majority most likely harbor masked H + retention. The present review probes this expanded concept of metabolic acidosis of CKD: the eubicarbonatemic H + retention or subclinical metabolic acidosis of CKD. It focuses on the high prevalence of the entity, its pathophysiologic features, its clinical course, and recent work on potential biomarkers of the condition. Further, it puts forward the urgent task of investigating definitively whether treatment with alkali of eubicarbonatemic H + retention delays CKD progression. If proven true, such knowledge would trigger a paradigm shift in the indication for alkali therapy in CKD.Complete author and article information provided before references.

Analysis of the Effectiveness of the Nurse-Led “Outpatient-Ward-Home” Management Model in Chronic Kidney Patients

“…e main clinical manifestation of CKD patients is reduced renal function, and BUN, Scr, and GFR are effective indicators to detect renal function. Some studies [23,24] have shown that lifestyle changes and dietary control of patients can improve their clinical and biochemical indicators and that this effect is independent of the effect of drug therapy.…”

Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy

“…Although metabolic acidosis determined by serum bicarbonate is uncommon in living kidney donors, subclinical metabolic acidosis called eubicarbonatemic metabolic acidosis may occur. Hydrogen ion retention with a normal range of serum bicarbonate can lead to muscle protein breakdown, bone loss, and CKD progression [43,44,45 ▪▪ ,46 ▪ ]. Although it remains challenging to identify eubicarbonatemic metabolic acidosis, the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guideline suggested oral bicarbonate supplementation in patients with CKD and serum bicarbonate concentrations <22 mmol/l to maintain serum bicarbonate within the normal range unless contraindicated [47].…”

“…Although metabolic acidosis determined by serum bicarbonate is uncommon in living kidney donors, subclinical metabolic acidosis called eubicarbonatemic metabolic acidosis may occur. Hydrogen ion retention with a normal range of serum bicarbonate can lead to muscle protein breakdown, bone loss, and CKD progression [43,44,45…”

The case for a ketogenic diet in the management of kidney disease

“…However, decreases in serum bicarbonate are often reported at a later stage of the disease and it is considered inadequate to reflect the overall acid load. Eubicarbonatemic hydrogen ion retention among patients with earlier CKD is increasingly an area of focus 81 ; thus, studying ketogenic diet in all stages of CKD requires longer term study of acid excretion and the rate of kidney function decline.…”