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Table 1 Potential adverse effects of metabolic acidosis in patients with chronic kidney disease

From: Differential effects of phosphate binders on pre-dialysis serum bicarbonate in end-stage kidney disease patients on maintenance haemodialysis

Effect

Comment

Muscle wasting

Seen with even mild metabolic acidosis (important factor in causing muscle wasting in patients with CKD)

Reduced albumin synthesis

Acidosis is one of many factors contributing to hypoalbuminemia in patients with CKD

Bone disease

Acidosis contributes to the genesis of bone disease by diverse mechanisms; contributory rather than primary mechanism in producing bone disease

Direct effects

• Physicochemical dissolution of bone• Decreased function of osteoblast

• Increased function of osteoclast

Indirect effects

• Increased release of parathyroid hormone

• Increased number of parathyroid hormone receptors

• Increased binding of parathyroid hormone to its receptor

• Decreased activity of 1-a hydroxylase

Impaired insulin sensitivity

Effect unclear given the impact of changes in insulin metabolism with renal failure; could induce metabolic changes similar to those seen in syndrome X*

B2-Microglobulin accumulation

Found with studies of acetate v bicarbonate dialysis in dialysis patients; no studies of patients with CKD not on dialysis therapy

Exacerbation of renal failure

Data for and against role of acidosis in progression of renal failure

Impaired thyroid metabolism

May contribute to abnormalities in basal metabolic rate

Stunted growth in children

Reversed in part by correction of acidosis

Cardiac disease

Role in the development of cardiac disease is theoretical, not proven

Increased inflammation

Conflicting evidence for and against the role of acidosis in dialysis patients

  1. Syndrome X* is characterized by dislipidemia, hyperinsulinemia, hypertension, abdominal obesity, glucose intolerance and renal resistance.
  2. From Kraut JA et al. [1]: Metabolic Acidosis of CKD: Diagnosis, Clinical Characteristics and Treatment. AJKD 2005;45(6):978–93.