A 52-year-old man with CKD stage 4 (eGFR 22 mL/min) has serum bicarbonate of 16 mEq/L. According to KDIGO guidelines, what is the target bicarbonate and how should it be treated?

• A Target bicarbonate >26 mEq/L; IV sodium bicarbonate infusion
• B No treatment needed until bicarbonate falls below 10 mEq/L
• C Target bicarbonate 18-20 mEq/L; dietary protein restriction only
• D Target bicarbonate >22 mEq/L; oral sodium bicarbonate supplementation ✓

Explanation

KDIGO 2012 CKD guidelines recommend treating metabolic acidosis in CKD to maintain serum bicarbonate within normal range (22-29 mEq/L), using oral sodium bicarbonate supplementation. The BICARB trial and others have shown that alkali supplementation slows CKD progression. The serum bicarbonate target of ≥22 mEq/L is the standard goal; IV therapy is not required for stable CKD. Untreated metabolic acidosis accelerates protein catabolism, bone disease (buffering by bone carbonate), and progression of CKD.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.