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

Arrow showing the levels 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-recognized*1,8-10

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

*Defined as underdiagnosed and/or undertreated.

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

Metabolic acidosis is underdiagnosed and undertreated in patients with CKD18,19

Download the Tangri Poster #FR-PO632, ASN, 2019 for more information about these data

Hear from a Nephrologist

Navdeep Tangri, MD, PhD:
Metabolic acidosis is underdiagnosed and undertreated in patients with CKD

‡Dr Tangri is a paid consultant of TRICIDA, Inc.

Download Dr Tangri's presentation featured in this video

Continue to the next page to learn more about metabolic acidosis as an independent risk factor for CKD progression

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Read More

Tangri Poster #FR-PO632, ASN, 2019:
Metabolic acidosis is underdiagnosed and undertreated in patients with chronic kidney disease
download poster
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 Guidelines (2002):
NKF-KDOQI Clinical Practice Guidelines for chronic kidney disease evaluation, classification, and stratification
ACCESS THE GUIDELINES