Chronic Kidney Disease, Metabolic Acidosis and why acid/base balance is so important.

Over 24 million people in the United States have Chronic Kidney Disease or CKD per the CDC or Centers for Disease Control. Kidney disease ranges between Stage 1 when the kidneys start to have mild or minimal disfunction to Stage 5 sometimes called ESRD or End Stage Renal Disease, where the kidneys have complete or near complete loss of function, requiring dialysis or kidney transplant

About Metabolic Acidosis or elevated serum acid and CKD.

Chronic metabolic acidosis is a condition which occurs in a significant number of individuals who develop chronic kidney disease (CKD). Our body produces acid as part of daily functioning. This acid (which is different from stomach acid) is cleared by the kidneys. If kidney function declines, the acid can build up in the body and cause problems like accelerated progression of kidney disease, muscle wasting, bone disease, inflammation and malnutrition. The kidneys are a key part in keep blood pH in a narrow balance. When pH is too low, and the kidneys don't have the ability to raise pH and reduce blood acid, metabolic acidosis can occur.

Metabolic acidosis in chronic kidney disease is diagnosed with a routine blood test which is included as part of the kidney function panel or metabolic panel. The test is called many things including serum bicarbonate, Total CO2,TCO2, CO2 or Carbon Dioxide. The optimal value of bicarbonate (or Total CO2) ranges between 23-29 meq/L. A serum bicarbonate of less than 22 meq/L in individuals with kidney disease is usually considered significant enough to require treatment with an acid buffering agent such as sodium bicarbonate.

Correcting elevated serum acid levels can slow kidney disease and the loss of kidney function.

Correcting metabolic acidosis or elevated serum acid levels with sodium bicarbonate has been shown to delay the progression of kidney disease and loss of kidney function. For more information on the importance of managing bicarbonate levels and reducing serum acid levels, please see the Bicarbonate Case studies page.

GI upset with raw uncoated sodium bicarbonate.

Published clinical data shows that around 35% of CKD patients taking raw uncoated sodium bicarbonate therapy cannot tolerate the therapeutic dose need to reach their bicarbonate (TCO2) goal. The primary reason is excessive bloating, belching or burping and acid reflux. Bicarbi is GI friendly enteric coated sodium bicarbonate, designed of offer the benefits of bicarbonate, with the GI side effects of raw uncoated sodium bicarbonate.

Frequently Asked Questions about Bicarbi

Click on any question to expand the answer

  • Each capsule of Bicarbi contains 650 mg of sodium bicarbonate in an enteric coated capsule. Bicarbi is used to treat metabolic acidosis or elevated blood acid levels. The acid in blood with metabolic acidosis is different from stomach acid. Elevated blood acid occurs when the body produces excessive quantities of acid or the kidneys aren't removing enough acid from the blood.
  • Yes, several studies have shown that improving low serum bicarbonate levels with sodium bicarbonate can slow the progression of kidney disease. 4,5 One study even showed not only did improving low serum bicarbonate level reduce the risk of kidney failure but it also improved the nutritional status of people with kidney disease.4 This said, raising low bicarbonate levels is only one part in improving outcomes for those with chronic kidney disease. Your health care provider will give you guidance on controlling blood pressure, controlling glucose, potential weight loss and some dietary requirements. All of these and more are modifiable factors in improving the outcome of chronic kidney disease or CKD. See 'References' in the 'About Metabolic Acidosis' section if you are interested in some of the published clinical data about improving bicarbonate levels in CKD.
  • Sodium bicarbonate is an acid buffer or a base. It is often used to treat metabolic acidosis. Sodium Bicarbonate is the same as baking soda used in cooking.
  • Bicarbi is new and many Health Care Providers don't yet know about it. Ask your HCP about the benefits of Bicarbi versus raw sodium bicarbonate.
  • Bicarbi has an enteric coating so the sodium bicarbonate in Bicarbi won’t react with stomach acid. When un-coated sodium bicarbonate is taken, some of it reacts with the acid in the stomach and is lost and turned into carbon dioxide gas before it can enter the small intestine. When the bicarbonate is lost to carbon dioxide gas some potency is lost. The production of carbon dioxide gas from uncoated sodium bicarbonate reacting with stomach acid may also increase gastric discomfort, boating, belching or burping.
  • Your healthcare provider will guide you on your specific dosing for Bicarbi. The typical dose for Bicarbi is one capsule twice daily. Dosing can vary depending on your current needs. The need for bicarbonate supplementation and adjustment can change.
  • Resources where you can learn more about Metabolic Acidosis and Chronic Kidney disease include the NKF-National Kidney Foundation, the AAKP-American Association of Kidney Patients and UpToDate.


  1. Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update.
    Am J Kidney Dis. 2015 Oct 15
  2. Starke A, Corsenca A, Kohler T, Knubben J, Kraenzlin M, Uebelhart D, et al. Correction of metabolic acidosis with potassium citrate in renal transplant patients and its effect on bone quality.
    Clin J Am Soc Nephrol. 2012 Sep. 7(9):1461-72
  3. Abramowitz MK, Melamed ML, Bauer C, Raff AC, Hostetter TH. Effects of oral sodium bicarbonate in patients with CKD.
    Clin J Am Soc Nephrol. 2013 May. 8(5):714-20
  4. De Brito-Ashurst L, Varagunam M, Raferty J, Yaqoob M. Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status.
    J Am Soc Nephrol. 2009 , 20: 2075-2084
  5. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Association of serum bicarbonate levels with mortality in patients with non-dialysis dependent CKD.
    Nephrol Dial Tranplant 2009; 24:1232.