Is Metabolic Acidosis a Friend or Foe for Cardiovascular Disease in Kidney Transplant Recipients?

Metabolic acidosis, typically inferred from serum total carbon dioxide (tCO2) measurements, has emerged as a potentially modifiable determinant for a number of clinical outcomes. Low tCO2 levels are independently associated with chronic kidney disease (CKD) progression, incident functional limitation, poorer global cognition, and the development or exacerbation of bone disease.1-4 Supporting the notion that metabolic acidosis plays a causal role in these clinical outcomes, bicarbonate supplementation has been suggested to slow CKD progression, including progression to end-stage kidney disease, among patients with low tCO2 levels in small single-center interventional studies.

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