American Journal of Kidney Diseases Tolerance to Sodium in Patients With CKD-Induced Metabolic Acidosis: Does the Accompanying Anion Matter?  David A. Bushinsky  American Journal of Kidney Diseases  DOI: 10.1053/j.ajkd.2018.09.004 Copyright © 2018 The Author Terms and Conditions

Figure 1 Changes in body weight and systolic blood pressure (mean ± standard error of the mean) noted in (A) Husted et al 1975 and (B) Husted and Nolph 1977 studies. All participants had chronic kidney disease with baseline serum bicarbonate levels < 22 mEq/L. All patients were maintained on a 10-mEq/d NaCl diet throughout the study. Mean changes in body weight and systolic blood pressure were observed from study day 1 to day 5 during treatment. Graphs are based on data in references 25 and 26. Abbreviations: NaCl, sodium chloride; NaHCO3, sodium bicarbonate. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.09.004) Copyright © 2018 The Author Terms and Conditions

Figure 2 Effect of sodium load from sodium bicarbonate (NaHCO3) treatment in chronic kidney disease. In this model based on published literature, a very restrictive sodium chloride (NaCl) diet (10-30mEq/d) is required to prevent unwanted sodium retention accompanying NaHCO3 treatment. Lower NaCl diets (90-104mEq/d) as recommended by guidelines may not prevent sodium retention with alkali treatment. Abbreviations: KDOQI, Kidney Disease Outcomes Quality Initiative; KDIGO, Kidney Disease: Improving Global Outcomes. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.09.004) Copyright © 2018 The Author Terms and Conditions