(Press-News.org)
Niigata Japan - A Japanese registry has identified a blind spot in the routine care of patients with chronic kidney disease (CKD). Serum bicarbonate levels are rarely measured, leaving metabolic acidosis largely undetected and hence, undertreated.
Metabolic acidosis is a common complication of CKD and is associated with muscle loss, bone disease, insulin resistance, accelerated kidney decline, and increased mortality. Clinical guidelines recommend treatment when the serum bicarbonate level falls below 22 mEq/L. However, real-world data from Asia have been limited.
To address this, Mai Tanaka and colleagues extracted nationwide data from more than 21 university hospitals through the Japan Chronic Kidney Disease Database Extension (JCKDDBEx) and evaluated bicarbonate measurement, diagnosis, and treatment patterns in adults with CKD stages 3a–4 between 2014 and 2021 as seen in Figure 1.
The key finding was that serum bicarbonate was rarely tested in routine CKD care. “The annual measurement rate of serum bicarbonate levels in Japanese patients with CKD stages 3a to 4 was consistently below 10%, suggesting that metabolic acidosis itself may be underassessed,” says the lead author of the study, Mai Tanaka.
Because testing was so infrequent, the prevalence of metabolic acidosis appeared very low in the overall CKD population, reflecting limited measurement rather than the actual absence of the disease. However, when the analysis focused on patients who actually had bicarbonate measured, a very different picture emerged. Nearly half of the population met the criteria for metabolic acidosis, and its prevalence increased with more advanced CKD.
The study showed that even among cases with serum bicarbonate levels below 22 mEq/L, the gap between diagnosis and treatment was concerning; the diagnosis and treatment rates were only 8.6% and 7.5%, respectively. Tanaka added, “the rate of serum bicarbonate measurement was low in CKD patients, suggesting that more attention to metabolic acidosis is needed in routine CKD care.”
A large real-world analysis across the American and Canadian cohorts led by Abramowitz and Whitlock revealed that metabolic acidosis remains undiagnosed in many CKD cases. Fewer than 20% patients received sodium bicarbonate therapy, and may cases remained unrecognized in administrative records. Furthermore, acid retention accelerates kidney damage through pathways that promote tubulointerstitial injury and fibrosis; dietary acid load further complicates the picture. Together, these findings suggest that the gap observed in Japan reflects a broader global pattern.
Clinical guidelines, including those issued by the Japanese Society of Nephrology, recommend monitoring metabolic complications of CKD and correcting acidosis when present to maintain serum bicarbonate at or above 22 mEq/L. Yet, routine implementation appears inconsistent in standard CKD management workflows, as shown by Tanaka’s study. Serum bicarbonate measurement is inexpensive and widely available. The barrier appears to be awareness and routine care.
Nonetheless, this is a clear opportunity to conduct a systemic assessment of bicarbonate in CKD patients that could substantially improve the detection of metabolic acidosis. Earlier recognition may enable a timely initiation of alkali therapy or dietary interventions, both of which seem promising for slowing kidney function decline.
For clinicians and health systems, the findings highlight an actionable quality improvement target: incorporating bicarbonate testing into standard CKD monitoring panels. As CKD prevalence rises globally, particularly in aging populations, closing this assessment gap by ensuring that metabolic complications are routinely evaluated may represent a practical and scalable strategy to improve outcomes.
The study’s message is straightforward but powerful, metabolic acidosis in CKD may be hidden in plain sight, not because it is uncommon, but because it is not consistently measured.
END
Australian media release (see below for North American media release)
A landmark Lancet Psychiatry paper published today – the largest-ever review of the safety and efficacy of cannabinoids across a range of mental health conditions – found no evidence that medicinal cannabis is effective in treating anxiety, depression or post-traumatic stress disorder (PTSD).
The study comes amid more than one million prescription approvals and a tripling of sales of cannabinoid medications (including ...
The Lancet Global Health: Modelling suggests climate change could drive millions globally into physical inactivity by 2050 and be linked to an estimated half a million premature deaths
Rising temperatures due to climate change could drive millions more adults globally into physical inactivity by 2050, being linked to hundreds of thousands of premature deaths and billions of dollars in lost productivity, suggests a modelling study published in The Lancet Global Health journal.
Climate change is making the world hotter, and this growing heat is likely to affect how active people can be. Physical inactivity is already a major global health problem, ...
UNDER EMBARGO UNTIL 23:30 UK TIME ON MONDAY 16 MARCH 2026
Fathers’ health crucial to improving pregnancy and child outcomes
Researchers say boys and men are an important but ‘persistently under-appreciated’ population for measures to improve the health of the next generation of children
Improving health and well-being of future fathers critical to addressing intergenerational disparities and legacies of racism
A focus on shared responsibility for pregnancy and parenthood ...
Under embargo to Monday 16 March 2026, 23:30 UK time
Peer reviewed / Survey
Major step towards a first global system to track health before pregnancy
The key health and social indicators needed for a new global system to monitor people’s health before pregnancy have been identified for the first time by researchers at University College London and the University of Southampton.
As more women are becoming pregnant with health conditions that can complicate pregnancy and childbirth, such as obesity, diabetes ...
A new study published in The Lancet Global Health reveals a previously underappreciated tension at the heart of international climate negotiations: policies designed to protect developing countries from bearing an unfair share of the cost of cutting carbon emissions could inadvertently deprive those same countries of millions of life-saving air quality improvements. The leaders of the study also identify a promising way to resolve this dilemma.
The study, conducted by researchers at The University of Texas at Austin, Emory University, Princeton University, and collaborators across six countries, modeled ...
Bull sharks form social relationships with specific “friends”, new research reveals.
Sharks are often viewed as solitary, but the study – carried out on the Shark Reef Marine Reserve in Fiji – found that rather than mixing at random, sharks have “active social preferences” and choose their social partners.
The research was carried out by the University of Exeter, University of Lancaster, Fiji Shark Lab, and Beqa Adventure Divers.
“As humans we cultivate a range of social relationships – from casual acquaintances to our best friends, but we also actively avoid certain ...
PROVIDENCE, R.I. [Brown University] — People with Alzheimer’s disease often have other neurodegenerative conditions as well, including a less-understood disorder called frontotemporal lobar degeneration (FTLD). While a precise diagnosis of FTLD has only been possible during an autopsy, new research shows how clinicians may be able to diagnose people living with both Alzheimer’s and FTLD by evaluating neuropsychiatric symptoms.
In a study published in Neurology, researchers found that compared to patients who have either of the two types of dementia alone, having both Alzheimer’s disease and FTLD is associated with greater likelihood of having known neuropsychiatric symptoms ...
Even 200 years after asteroid 16 Psyche was discovered, astronomers continue to puzzle over its formation.
Psyche is the 10th-most massive asteroid in the main belt between Mars and Jupiter, and the largest known metallic asteroid, at 140 miles in diameter. NASA's Psyche mission will arrive in 2029 to determine its origin. Psyche may be a leftover building block of an early planet, shredded by violent collisions, or a planetary fragment that once separated into layers before losing its rocky outer mantle.
Other hypotheses suggest Psyche is an ancient remnant that either started metal-rich ...
A new study reports that a biochar-enhanced photocatalyst can efficiently degrade antibiotic contaminants in water, offering a promising strategy for addressing one of the growing threats to global water quality.
The research, published in the journal Biochar, describes the development of a ternary composite material composed of biochar, titanium dioxide, and graphitic carbon nitride. The material demonstrated remarkable ability to break down sulfadiazine, a widely used sulfonamide antibiotic that is frequently detected in aquatic environments.
Antibiotic pollution has become ...
Embargoed for release until 5:00 p.m. ET on Monday 16 March 2026
Follow @Annalsofim on X, Facebook, Instagram, Bluesky, and LinkedIn
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own ...
