No Good Deed: Acidosis in Chronic Kidney and Liver Disease.

Abstract

OBJECTIVE:

Studies have shown that low or high serum bicarbonate levels (reflecting metabolic acidosis or alkalosis) are associated with increased all-cause mortality rates in moderate and advanced chronic kidney disease (CKD) cases. Correction of presumed acidosis using sodium bicarbonate, targeting serum levels around 22 mmol/L, has proven to be beneficial in delaying the progression of the disease and provided mortality benefit. A similar prognostic association may exist between uncorrected metabolic acidosis in chronic liver disease. Correcting it with sodium-containing salts may require more interventions due to increased sodium/fluid load. In patients with liver failure, a naturally alkalotic state, where sodium load is a concern, the impact of this intervention is unclear.

DESIGN:

This study aims to generate proof of concept through a retrospective chart review in individuals with CKD-related metabolic acidosis and liver cirrhosis.

RESULT:

Our analysis revealed a statistically significant association between the need for paracentesis and bicarbonate therapy. Our study has multiple drawbacks, including a retrospective chart review and limitation of data due to single-center patients.

CONCLUSION:

We extrapolate that lowering bicarbonate targets in other clinical scenarios like liver failure, pregnancy, and cardiac failure may be prudent and will lead to a lower sodium load.

• Authors: Samira Chandra, Sreelakshmi Ravula, Praveen Errabelli, Horace Spencer, Manisha Singh
• Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation (J Ren Nutr) Vol. 33 Issue 3 Pg. 499-502 (05 2023) ISSN: 1532-8503 [Electronic] United States
• PMID: 36736470 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Bicarbonates
• Sodium

Topics

• Humans
• Bicarbonates
• Retrospective Studies
• Acidosis (complications, drug therapy)
• Chronic Disease
• Renal Insufficiency, Chronic
• Sodium
• Liver Diseases (complications)
• Kidney
• Liver Failure (complications)