Retarding progression of chronic kidney disease: use of modalities that counter acid retention

Curr Opin Nephrol Hypertens. 2018 Mar;27(2):94-101. doi: 10.1097/MNH.0000000000000386.

Abstract

Purpose of review: Acid retention because of chronic kidney disease (CKD) increases tissue acidity and accelerates progression of CKD, whereas reduction in acid retention slows progression of CKD. Herein, we describe the mechanisms through which increased tissue acidity worsens CKD, modalities for countering acid retention and their impact on progression of CKD, and current recommendations for therapy.

Recent findings: Studies in animals and humans show that increased tissue acidity raises the renal levels of endothelin, angiotensin II, aldosterone, and ammoniagenesis, thereby worsening renal fibrosis and causing progression of CKD. Measures that counter acid retention, such as providing alkali or modifying the quantity or type of dietary protein, reduce the levels of endothelin, angiotensin II, aldosterone, and ammoniagenesis, slowing progression of CKD. Alkali can be provided as NaHCO3, sodium citrate, or base in fruits and vegetables. A serum [HCO3] of 24-26 mEq/l is targeted, because higher values can be associated with adverse consequences.

Summary: Insights into the mechanisms through which increased tissue acidity mediates progression of CKD and the beneficial impact of ameliorating positive acid balance underlie our recommendation for modalities that counter acid retention in CKD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Acid-Base Imbalance / complications
  • Acid-Base Imbalance / metabolism*
  • Acid-Base Imbalance / therapy*
  • Aldosterone / metabolism
  • Angiotensin II / metabolism
  • Animals
  • Buffers
  • Citrates / therapeutic use
  • Dietary Proteins / metabolism
  • Disease Progression
  • Endothelins / metabolism
  • Fibrosis
  • Fruit
  • Humans
  • Kidney / metabolism*
  • Kidney / pathology*
  • Renal Insufficiency, Chronic / metabolism*
  • Renal Insufficiency, Chronic / therapy*
  • Sodium Bicarbonate / therapeutic use
  • Sodium Citrate
  • Vegetables

Substances

  • Buffers
  • Citrates
  • Dietary Proteins
  • Endothelins
  • Angiotensin II
  • Sodium Citrate
  • Aldosterone
  • Sodium Bicarbonate