Retrospective analyses and single-center prospective studies identify chronic metabolic
acidosis as an independent and modifiable risk factor for progression of CKD. In patients
with CKD, untreated chronic metabolic acidosis often leads to an accelerated reduction in
GFR. Mechanisms responsible for this reduction include adaptive responses that increase
acid excretion but lead to a decline in kidney function. Metabolic acidosis in CKD stimulates
production of intrakidney paracrine hormones including angiotensin II, aldosterone, and …