About Metabolic Acidosis

Metabolic acidosis in CKD is caused by the kidney’s reduced ability to excrete acid1

Acid-base balance is essential for proper functioning of organs, tissues and cells2

Metabolic acidosis is diagnosed by the level of bicarbonate in the blood1

Image of patient's acid-base status measured by the level of bicarbonate in the blood

Serum bicarbonate levels determine severity of acidosis

  • The measurement of serum bicarbonate is part of a standard metabolic panel5
  • The normal range for serum bicarbonate is between 22 and 29 mEq/L6
  • Chronic metabolic acidosis is defined as a persistent bicarbonate level below 22 mEq/L in the absence of lung disease1
  • Metabolic acidosis is more prevalent at the later, more severe stages of CKD where there is increased kidney impairment1,7

Metabolic acidosis is common, but often under-recognized1,8-10

Pie Chart depicting the different stages of metabolic acidosis and the number of adults within the stages. CKD Stage 3a - 1.4 Million Metabolic Acidosis Patients. CKD Stage 3b - 1.1 Million Metabolic Acidosis Patients.  CKD Stage 4 & Stage 5 (non-dialysis) > 600 Thousand Metabolic Acidosis Patients. Pie Chart depicting the different stages of metabolic acidosis and the number of adults within the stages. CKD Stage 3a - 1.4 Million Metabolic Acidosis Patients. CKD Stage 3b - 1.1 Million Metabolic Acidosis Patients.  CKD Stage 4 & Stage 5 (non-dialysis) > 600 Thousand Metabolic Acidosis Patients.

*Data on file. NHANES 1999-2004 reports prevalence of CKD Stages 3 and 4 for the US adult population ages 20 and older. CKD Stage 3 and 4 prevalence was calculated using NHANES prevalence and 2016 US Census data. Stage 3a (70%) and 3b (30%) were approximated using NCCD-CDC Surveillance System; Stage 5 non-dialysis included based on Inker et al grouping of Stage 4 & 5 prevalence rate. Metabolic acidosis prevalence by Stage 3a, 3b, 4, and 5 reported by Inker et al (2011).

Approximately 3 million* CKD patients in the US have metabolic acidosis, but roughly one-third are diagnosed8,11,14,15

Continue to the next page to learn more about the underlying pathophysiology

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Inker LA et al (2011):
Estimated GFR, albuminuria, and complications of chronic kidney disease
Go to Article
Kidney Disease Improving Global Outcomes® (2012):
KDIGO Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease
Access the Guidelines
National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Clinical Practice Guidlelines (2002):
NKF-KDOQI Clinical Practice Guidelines for chronic kidney disease evaluation, classification, and stratification
ACCESS THE GUIDELINES