Effects of correcting metabolic acidosis in chronic kidney disease patients: An umbrella review.

Metabolic acidosis is a frequent complication when chronic kidney disease (CKD) develops, plus it is linked to adverse outcomes such as muscle wasting, inflammation, and progression of kidney disease. This article is intended to evaluate how correcting metabolic acidosis affects adult CKD patients via summarizing evidence from systematic reviews with meta-analyses. We conducted an umbrella review. Systematic reviews with meta-analyses assessing alkali therapy in CKD patients were included. Methodological quality was assessed using a Measurement Tool to Assess Systematic Reviews (AMSTAR 2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty of evidence approach was used for rating the certainty of evidence. Twelve meta-analyses that were published between 2007 and 2024 were analyzed, and these included 169 associations, out of which 128 remained after excluding single-study outcomes. Only 8 (6.2%) of these associations were supported by high-certainty evidence, which included a slower decline in glomerular filtration rate, reduced hospitalization rates, lower diastolic blood pressure, increased serum bicarbonate after short-term therapy, and reduced use of β-blockers and vasodilators. However, most associations (52.3%) were rated as having very low certainty. Less than 10% of the associations analyzed in the selected systematic reviews have high certainty of evidence, which underscores a significant gap between common clinical practices and the strength of the supporting evidence. Trial registration: PROSPERO CRD42024548458.