Metabolic acidosis and cardiovascular function in chronic kidney disease: A review

Metabolic acidosis (MA) is a very common finding in chronic kidney disease (CKD) and in cardiovascular disease due to the close relationship between the two organ systems. It depresses the myocardium; induces CKD; depresses urine acidification, bone mineral disease (CKD-BMD); and its presence reduces the quality of life, as well as increases cardiovascular events and mortality. The diagnostic strategies, patient assessment, treatment, prognostication, and possible patient referral entail good clinical acumen to prevent or limit complications, some of which can be fatal. Chronic metabolic acidosis in CKD is often associated with structural cardiac changes such as increased left ventricular mass and significant intradialysis blood pressure variations.The use of sevelamer, and the inhibitors of aldosterone in these patients could worsen MA; however, bicarbonate in the lower, upper normal, and elevated levels and its replacement could all be associated with various structural and functional cardiovascular changes.