[Bicarbonate: From physiology to treatment for all clinicians]

Nephrol Ther. 2018 Feb;14(1):13-23. doi: 10.1016/j.nephro.2017.02.014. Epub 2017 Nov 15.
[Article in French]


Acid-base regulation is essential to maintain homeostasis in humans. Carbonic acid/bicarbonate (H2CO3/HCO3-) couple is the most predominant extracellular buffer to keep plasma pH within a physiological range. The ability to (re)generate such a buffer is a key milestone that necessitates to understand a precise physiology of both renal tubule and digestive tract. Here, we first reviewed renal and digestive cycles of bicarbonate in physiology. We also reviewed pathological findings where acid-base disequilibrium is involved and nutritional and/or alkali therapy could be necessary. Secondly, data from clinical trials were synthesized. Alkali therapy, oral and parenteral, from mineral-based water, masterful preparations or pharmaceutics drugs, is regularly used in a wide range of clinical findings, even if supporting data are (often) of a low level of evidence. Bicarbonate is primarily used during contrast-induced nephropathy, metabolic acidosis in chronic kidney disease or nephrolithiasis in which alkaline urine is necessary. Cast nephropathy, rhabdomyolysis and tumor lysis syndrome make usually physicians prescribe alkali therapy even if this prescription is only supported by physiopathological data without any proven clinical results. Finally, bicarbonate is essential in the composition of dialysate in both hemodialysis and peritoneal dialysis.

Keywords: Bicarbonates; Dialysis solutions; Hydrogénocarbonates; Insuffisance rénale chronique; Physiologie; Physiology; Renal insufficiency chronic; Solutions de dialyse; Urolithiase; Urolithiasis.

Publication types

  • Review

MeSH terms

  • Acid-Base Equilibrium / physiology*
  • Acid-Base Imbalance / therapy
  • Bicarbonates / metabolism*
  • Bicarbonates / therapeutic use
  • Dialysis Solutions
  • Humans
  • Kidney / physiopathology
  • Renal Dialysis / methods
  • Renal Insufficiency, Chronic / therapy*


  • Bicarbonates
  • Dialysis Solutions