{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:31:05Z","timestamp":1777883465692,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Chronic Disease"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>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 \u03b2-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.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>PROSPERO CRD42024548458.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27558428251411463","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T05:33:31Z","timestamp":1775280811000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of correcting metabolic acidosis in chronic kidney disease patients: An umbrella review"],"prefix":"10.1177","volume":"17","author":[{"given":"Percy","family":"Herrera-A\u00f1azco","sequence":"first","affiliation":[{"name":"Facultad de Medicina, Universidad Cient\u00edfica del Sur, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8820-2605","authenticated-orcid":false,"given":"Miguel A.","family":"Huayta-Cortez","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, IN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1093-4937","authenticated-orcid":false,"given":"Juan R.","family":"Ulloque-Badaracco","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1913-5190","authenticated-orcid":false,"given":"Christian N.","family":"Rojas","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-6608","authenticated-orcid":false,"given":"Nella","family":"Altamirano-Cabezas","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-1108","authenticated-orcid":false,"given":"Vicente A.","family":"Benites-Zapata","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n para la Generaci\u00f3n y S\u00edntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2024","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024; 105(4S): S117\u2013S314.","journal-title":"Kidney Int"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25105187"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-024-02912-5"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.13330"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.13091118"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.02.027"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae200"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.5527\/wjn.v14.i1.101078"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.17843\/rpmesp.2021.381.6501"},{"key":"e_1_3_3_11_2","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.5","author":"Higgins JPT","year":"2024","unstructured":"Higgins JPT, Thomas J, Chandler J, et al. (eds). Cochrane handbook for systematic reviews of interventions version 6.5 (updated August 2024). Cochrane, 2024."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-070849"},{"key":"e_1_3_3_13_2","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea BJ","year":"2017","unstructured":"Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358: j4008.","journal-title":"BMJ"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.007"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2023.101484"},{"key":"e_1_3_3_16_2","unstructured":"Nel J. 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Dissertation North-West University 2020."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2024.03.001"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.12.019"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S344592"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8020208"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2021.2023023"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/fsn3.3627"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000487"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1159\/000339329"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000119"},{"key":"e_1_3_3_26_2","article-title":"Correction of chronic metabolic acidosis for chronic kidney disease patients","volume":"2007","author":"Roderick P","year":"2007","unstructured":"Roderick P, Willis NS, Blakeley S, et al. 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