ABSTRACT
Metabolic acidosis is a common, but not invariable, feature of chronic kidney disease. Serum [HCO3
] varies widely, but the average value typically falls as serum creatinine concentration rises (Fig. 1) (1,2). Metabolic acidosis is not confined to advanced renal insufficiency; serum [HCO3
] often is below normal in individuals with creatinine values of only 2mg=dL (1,2). As serum creatinine concentration rises to >4mg=dL, however, serum [HCO3
] typically falls to 16-20mEq=L in most patients. This chapter addresses the nature and causes of this metabolic acidosis and reviews its potentially deleterious effects and management.
