The Balance of the Evidence on Acid-Base Homeostasis and Progression of CKD

Normalization of acid-base homeostasis in CKD holds promise for mitigating disease progression, but whether efforts should focus on patients with low serum bicarbonate or high dietary acid load is not known. In this issue Vallet et al contribute to this debate with a report that low urinary ammonia excretion independently associates with increased progression in moderate CKD. Whether this finding implicates differences in endogenous acid production or the ability to excrete an acid load in the pathogenesis of progression requires further study.