What role do bicarbonate supplements play in the management of metabolic acidosis in adults?

Bicarbonate supplements play a targeted role in the management of metabolic acidosis in adults, particularly in the context of chronic kidney disease (CKD). They are used to correct acid-base imbalance by increasing serum bicarbonate levels, thereby reducing the acid load and mitigating the complications associated with chronic metabolic acidosis.

According to UK NICE guidelines (NG203), bicarbonate supplementation is recommended for adults with CKD who have persistent metabolic acidosis, typically when serum bicarbonate levels fall below 22 mmol/L, to slow progression of kidney disease and improve clinical outcomes ¹.

Supporting this, recent meta-analyses of clinical studies demonstrate that oral sodium bicarbonate supplementation effectively maintains acid-base balance and may improve cardiovascular parameters in patients undergoing chronic hemodialysis, a population prone to metabolic acidosis (Voiculeț et al., 2016). Furthermore, sodium bicarbonate treatment in CKD patients with metabolic acidosis has been associated with improved clinical outcomes, including slower decline in renal function and reduced mortality risk (Yang et al., 2024).

Thus, bicarbonate supplements are primarily indicated to correct metabolic acidosis in adults with CKD, aiming to restore serum bicarbonate to normal levels, reduce acid retention, and potentially improve long-term renal and cardiovascular outcomes. However, their use should be carefully monitored to avoid complications such as volume overload or alkalosis, especially in patients with comorbidities.