{"doi":"10.1093/ndt/gfaa309","title":"Acidosis in renal disease: should we be concerned?","abstract":"In chronic kidney disease (CKD), as glomerular filtration rate (GFR) declines, there is a proportional reduction in serum bicarbonate. This is thought to be the result of (i) the kidney's inability to synthesize ammonia, regenerate bicarbonate and excrete hydrogen ion; and (ii) loss of alkali in the urine due to a failure of renal bicarbonate conservation. Metabolic acidosis of CKD, generally defined as serum bicarbonate persistently below 22 mmol/L, occurs as net acid excretion falls below net endogenous acid production. An estimated 19% of patients with CKD Stages 4–5 have metabolic acidosis; however, the prevalence increases as kidney function declines [1]. Certain conditions associated with defects in tubular acid excretion (i.e. hyporeninemic hypoaldosteronism in obstructive nephropathy, sickle cell nephropathy and diabetic nephropathy) are associated with a reduction in acid excretion at earlier stages of CKD [2]. Evidence suggests that alteration in ammonium excretion may precede the actual decline in serum bicarbonate level and portend poor outcomes [3]. We are using the term 'bicarbonate' as this is the conventional clinical expression; however, the standard laboratory test for this analyte in serum measures total CO2, which primarily consists of bicarbonate, but also includes available forms of carbon dioxide (i.e., dissolved CO2 and carbonic acid).","journal":"Nephrology Dialysis Transplantation","year":2020,"id":112909,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9576,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":292966,"name":"Mirela Dobre","orcid":"0000-0002-9059-9998","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:13:17.845093Z","pmid":"33313681","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}