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Metabolic Acidosis in CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseMetabolic Acidosis in CKDESENeph

A 55-year-old man with diabetic nephropathy has a serum bicarbonate of 16 mmol/L and eGFR of 22 mL/min/1.73m2. pH is 7.30, pCO2 3.8 kPa. What does KDIGO 2024 recommend regarding his metabolic acidosis?

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Correct answer: A — Consider pharmacological treatment to prevent clinical implications of acidosis when bicarbonate <18 mmol/L

KDIGO 2024 practice point 3.10.1 recommends considering pharmacological treatment with or without dietary intervention to prevent development of acidosis with potential clinical implications when serum bicarbonate is <18 mmol/L in adults. Oral sodium bicarbonate (typically 500 mg to 1 g TDS) is the usual first-line treatment. Acidosis accelerates CKD progression, muscle wasting, and bone disease. Treatment should avoid overcorrection above the upper limit of normal.

Reference: KDIGO 2024 – CKD Guideline