Clinical approaches to the treatment of metabolic acidosis in chronic kidney disease

Balaban D.D., Salmina E.V., Magomedov M.I., Makhova Yu.E., Blokhina A.D.

1) Ivanovo State Medical University, Ivanovo, Russia; 2) Sechenov First Moscow State Medical University, Moscow, Russia; 3) Kuban State Medical University, Krasnodar, Russia; 4) Privolzhsky Research Medical University, Nizhny Novgorod, Russia; 5) Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia

This article examines current clinical approaches to the treatment of metabolic acidosis in chronic kidney disease (CKD). It presents data on the pathogenetic mechanisms of metabolic acidosis and its role in the progression of renal dysfunction and the development of systemic complications. Epidemiological data characterizing the prevalence of CKD and the incidence of metabolic acidosis at various stages of the disease are analyzed. The provisions of international and national clinical guidelines are summarized. It is shown that the use of alkaline preparations increases serum bicarbonate concentrations and corrects acid-base imbalances. Data on the effect of alkaline therapy on the dynamics of estimated glomerular filtration rate (eGFR), nutritional status, and hospitalization rates are analyzed. The limitations of the evidence base regarding the impact of this therapy on clinical endpoints are highlighted. It was demonstrated that the use of higher doses of sodium bicarbonate, compared with standard regimens, is associated with a slower decline in eGFR and a lower incidence of CKD progression. New pharmacological approaches to sodium-independent correction of metabolic acidosis are discussed. Veverimer was shown to provide a stable increase in bicarbonate concentrations but did not demonstrate a significant effect on CKD progression. Directions for further research aimed at clarifying optimal treatment initiation thresholds and its impact on long-term clinical outcomes are identified.

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About the Authors

Danila D. Balaban – 6-year Student of the Faculty of General Medicine, Ivanovo State Medical University. Address: 8 Sheremetevsky Ave., Ivanovo, 153012; e-mail: danil.balaban02@list.ru. ORCID: 0009-0001-1728-667X
Elizaveta V. Salmina – 6-year Student of the Faculty of General Medicine, Sechenov First Moscow State Medical University (Sechenov University).
Address: Bldg. 2, 8 Trubetskaya St., Moscow, 119048; e-mail: lizochkasal@mail.ru. ORCID: 0009-0006-0393-0504
Magomed I. Magomedov – 6-year Student of the Faculty of General Medicine, Kuban State Medical University. Address: 4 Sedin St., Krasnodar, 350063;
e-mail: magomed200449@gmail.com. ORCID: 0009-0007-8534-2948
Iuliana E. Makhova – 6-year Student of the Faculty of General Medicine, Privolzhsky Research Medical University. Address: 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005; e-mail: maxovay@list.ru. ORCID: 0009-0008-9025-945X
A nastasiia D. Blokhina – 6-year Student of the Faculty of General Medicine, Pavlov First Saint Petersburg State Medical University. Address: 6–8 Lev Tolstoy St., Saint Petersburg, 197022; e-mail: mayak_32@mail.ru. ORCID: 0009-0004-1675-2191

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