Chronic metabolic acidosis (CMA) is a common cause and consequence of declining renal function and kidney disease.

CMA can drive kidney disease by causing inflammation and fibrosis, resulting in damage to kidney cells. Essentially what happens is that CMA activates renal release of angiotensin II and aldosterone. These are produced in an attempt to increase net acid excretion. These hormones upregulate hydrogen ion (H1) transporters in the proximal tubule and ascending limb of the loop of Henle, distal tubule, connecting tubule, and collecting duct. However, sustained release of these hormones also increases blood pressure and results in damage to the delicate micro-architecture of the kidneys.

There is a substantial body of evidence showing that there is direct damage to the kidneys as a consequence of acid retention leading to sustained increased levels of angiotensin II and aldosterone, resulting inflammation and fibrosis.

As kidney function declines there is reduced net acid excretion by the diseased kidneys, leading to further acid accumulation. A vicious, self-perpetuating cycle is then in place leading to worsening CMA and kidney disease. Systemic consequences of this metabolic acidosis include bone disease, increased muscle protein catabolism, increased systemic and localised kidney inflammation, insulin resistance, increased risk of cardiovascular disease, and progressive declines in estimated glomerular filtration rates (eGFR).

The inter-relationship between kidney functional and metabolic acidosis was the focus of a recent review, published in March 2020. In this review, the authors discussed mechanisms by which the adaptive response to metabolic acidosis, which promotes excretion of accumulated acid, becomes increasingly maladaptive, leading to progressive kidney injury with gradual loss of kidney function. They also reviewed how correction of systemic acidosis, through alkalising mineral therapy, can halt and even reverse the progression of declining kidney function.

The authors of this review concluded that: “…studies identify chronic metabolic acidosis as an independent and modifiable risk factor for progression of kidney disease. In patients with kidney disease, untreated chronic metabolic acidosis often leads to an accelerated reduction in eGFR. Treatment of chronic metabolic acidosis attenuates this damage and must be considered a cornerstone of any treatment plan aimed at supporting kidney health.”

If you have patients who are experiencing a decline in eGFR (i.e. eGFR readings below 90 ml/min), ensure you are utilising alkalising mineral citrates to improve their renal health today!

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REFERENCE

Wesson DE, Buysse JM, Bushinsky DA. Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney Disease. J Am Soc Nephrol. 2020 Mar;31(3):469-482. doi: 10.1681/ASN.2019070677.

WEBLINK: https://jasn.asnjournals.org/content/31/3/469.long