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CKD Metabolic Acidosis — RACP Adult Medicine MCQ

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EasyNephrologyCKD Metabolic AcidosisRACP Adult Medicine

A 60-year-old woman with CKD stage 4 (eGFR 20 mL/min/1.73 m²) is found to have a metabolic acidosis with serum bicarbonate of 16 mmol/L and a normal anion gap. What is the recommended treatment?

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Correct answer: E — Oral sodium bicarbonate supplementation

Non-anion-gap metabolic acidosis is common in CKD stage 4–5 due to impaired renal ammonia excretion and bicarbonate regeneration. KDIGO recommends oral sodium bicarbonate supplementation to maintain serum bicarbonate ≥22 mmol/L. The BiCARB trial showed that bicarbonate supplementation improved physical function but did not significantly slow eGFR decline. It also reduces muscle catabolism and bone demineralisation associated with chronic acidosis.

Reference: KDIGO – 2024 – CKD Guidelines; KHA-CARI – 2013 – CKD Complications