ACIDOSE METABÓLICA NA DOENÇA RENAL CRÔNICA: MECANISMOS, CONSEQUÊNCIAS E ABORDAGENS TERAPÊUTICAS

Metabolic acidosis is a common complication of chronic kidney disease (CKD) and is associated with various adverse outcomes, including the progression of renal dysfunction, impaired musculoskeletal health, cardiovascular events, and mortality. The mechanisms that prevent metabolic acidosis paradoxically contribute to further kidney damage, creating a cycle between acid accumulation and acid-mediated kidney injury. Interrupting this cycle through alkali administration, most commonly with sodium bicarbonate, is believed to preserve kidney function and mitigate the harmful effects of excess acid on bones and muscles. However, clinical trial results have been conflicting. Additionally, there is significant interest in determining whether sodium bicarbonate can improve clinical outcomes in patients without overt metabolic acidosis. It is hypothesized that these individuals may experience acid-mediated organ damage despite having normal serum bicarbonate concentrations—a condition often referred to as subclinical metabolic acidosis. Results from small to medium-sized clinical trials in individuals with subclinical metabolic acidosis have also been inconclusive. Therefore, well-designed and adequately powered clinical trials are necessary to evaluate the efficacy and safety of sodium bicarbonate and to determine whether this intervention can improve patient outcomes.