Acidosis Guideline

Guiding Principles

People with Advanced Chronic Kidney Disease (ACKD) are at increased risk of metabolic acidosis. This can lead to bone loss, muscle wasting, and fatigue. The primary intervention is the use of sodium bicarbonate.

In people with ACKD, consider using dietary and/or pharmacological treatment to prevent severe acidosis (e.g., bicarbonate <16 mmol/l). 

Monitor people with ACKD to ensure correction of serum bicarbonate does not result in concentrations exceeding the upper limit of normal and does not adversely affect BP control, serum potassium, or fluid status.

If the patient wishes to have treatment of acidosis for potential symptom benefits, it would be reasonable to monitor CO₂ every three months.

For patients receiving conservative kidney management, blood work and interventions should be based on patient preference. The primary goal  is to optimize function and quality of life compatible with level of frailty. Individualization is key

GFR 15 - 5 | Slow Decline/Deteriorating | Last 0-5 years of life

The recommended intervention for treating acidosis contributes to a higher pill burden for patients. However, there may be benefits in terms of bone health, nutrition and energy. Therefore, it may be reasonable for patients to continue taking sodium bicarbonate (if indicated) for as long as they feel that it is not burdensome.

GFR 5 - 0 | Intensive/Near Death | Last 0-2 months of life

When the patient is no longer able to swallow pills, or is bed-bound and approaching the end of life, it is appropriate to stop this intervention and related blood work.

Objectives

To guide the multidisciplinary approach to evaluation and management of metabolic acidosis in conservatively managed patients with CKD based on the following inclusion criteria:

• Serum total CO₂ less than 22 mmol/L
• Stable clinical status as determined by a physician

Patients will be excluded in the presence of:

• Overt CHF
• Uncontrolled hypertension (greater than 170 mmHg systolic)

Interventional guidelines do not replace individualized care and clinical expertise.