Chronic Kidney Disease (updated 2023) - CRASH! Medical Review Series 

ACUTE metabolic acidosis in the context of CKD and hemodialysis patients is associated with HYPOcalcemia (increased calcium excretion). So calcium carbonate may be a good option there. But CHRONIC metabolic acidosis can be associated with HYPERcalcemia (increased PTH). In the absence of hypocalcemia (e.g., a patient with metabolic acidosis but no CKD or hypocalcemia, which is most), sodium bicarbonate is better to prevent metastatic calcification. But we generally try to avoid giving base in metabolic acidosis unless it's severe. There are conflicting recommendations, but usually not unless the pH is less than 7.1. On exams, do not expect to be asked to pick one over the other, because there are conflicting recommendations on when to give which one. And in practice this should only be done in consultation with a nephrologist. Personally, I'd be reticent to treat severe metabolic acidosis in a CKD patient all on my own. Too many potential complications. For exam purposes, definitely pick sodium bicarb if base therapy is needed and there is no hypocalcemia. Here's some reading that compares different methods: www.ncbi.nlm.nih.gov/pmc/articles/PMC2991191/ Remember, as my disclaimer says, my videos are for exam review purposes. They should NOT be used to replace the professional judgment of a specialist -- in this case, a nephrologist.

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