Role of Acid-Base Homeostasis in Diabetic Kidney Disease

  • Pascale Khairallah
  • Julia J. Scialla
Microvascular Complications—Nephropathy (M Afkarian, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Microvascular Complications—Nephropathy


Purpose of Review

Acid-base homeostasis is impaired in chronic kidney disease (CKD) and may contribute to disease progression. Diabetes, a major cause of CKD worldwide, may exacerbate acidosis further due to differences in acid production and excretion. Here, we review the role of abnormal acid-base homeostasis in the pathogenesis and progression of diabetes and diabetic kidney disease.

Recent Findings

Acidosis and dietary acid loading may contribute to the development and worsening of insulin resistance and hypertension, thereby promoting diabetes and diabetic CKD. However, although metabolic acidosis associates with progression of CKD generally, the results in diabetic CKD are mixed. Data suggests that metabolic acid production in diabetes may be higher than would be predicted based on dietary intake alone, and new observational data suggests that this higher diet-independent acid production could potentially be protective.


The role of acid-base homeostasis in diabetic CKD progression is complex and must consider differences in endogenous acid production and excretion in diabetes. Ongoing observational and interventional studies in this field should consider the unique physiology of diabetes.


Acid load Acidosis Insulin resistance Diabetes Diabetic nephropathy CKD CKD progression 



This work is supported in part by K23DK095949 (JS) from the National Institute of Diabetes and Digestive and Kidney Diseases, a Stead Resident Research Award from the Duke University Department of Medicine (PK), and the Duke O’Brien Center for Kidney Research (P30DK096493).

Compliance with Ethical Standards

Conflict of Interest

Pascale Khairallah declares that she has no conflicts of interest relevant to the content of this work.

Julia J. Scialla reports personal fees from Ultragenyx and modest research support from Eli Lilly.

Human and Animal Rights and Informed Consent

Any reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of MedicineDuke University School of MedicineDurhamUSA
  2. 2.Duke Clinical Research InstituteDuke University School of MedicineDurhamUSA
  3. 3.Department of MedicineDurham Veterans Affairs Medical CenterDurhamUSA

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