Alkalization to retard progression of chronic kidney disease

Progression of chronic kidney disease (CKD) contributes to increasing end-stage kidney disease and so addressing factors that mediate CKD progression is an important investigative focus. Evolving studies support a spectrum of “acid (H+) stress” beyond metabolic acidosis that includes pathologic acid (H+) accumulation without changes in plasma acid–base parameters reflective of metabolic acidosis. The full spectrum of H+ stress prior to its manifestation as metabolic acidosis appears to cause kidney injury and progressive CKD. Recent studies support that alkali therapy done with diet and/or pharmacologically ameliorates H+ stress and retards CKD progression. This chapter discusses potential mechanisms for H+ stress–induced CKD progression and strategies by which clinicians can execute such alkali therapy.