Up Front MattersCurrent Status of Bicarbonate in CKDDobre, Mirela; Rahman, Mahboob; Hostetter, Thomas H. Author Information Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, Cleveland, Ohio Correspondence: Dr. Thomas H. Hostetter, Division of Nephrology and Hypertension, Case Western Reserve University, University Hospital Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. Email: [email protected] Journal of the American Society of Nephrology 26(3):p 515-523, March 2015. | DOI: 10.1681/ASN.2014020205 Buy Metrics Abstract Metabolic acidosis was one of the earliest complications to be recognized and explained pathologically in patients with CKD. Despite the accumulated evidence of deleterious effects of acidosis, treatment of acidosis has been tested very little, especially with respect to standard clinical outcomes. On the basis of fundamental research and small alkali supplementation trials, correcting metabolic acidosis has a strikingly broad array of potential benefits. This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications. Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.