Metabolic acidosis in canine CKD: when and how to treat it
10-year-old English Setter with IRIS stage 3 CKD, stable and hydrated, that has been on a renal diet for 6 weeks. He has less appetite and has lost muscle mass.
| Parameter | Result | Reference |
|---|---|---|
| Venous bicarbonate | 14 mmol/L | 18–24 |
| Potassium | 4.0 mmol/L | 3.5–5.5 |
| Creatinine | 3.4 mg/dL | 0.5–1.5 |
What is the most appropriate course of action?
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A. No treatment: the acidosis of CKD is respiratory-compensated and has no consequences
Chronic metabolic acidosis promotes muscle catabolism, hyporexia and CKD progression; with persistently low bicarbonate, it is treated.
B. Intravenous sodium bicarbonate bolus until pH normalises
Intravenous bicarbonate is reserved for severe acute acidosis (pH < 7.1–7.2) under hospital monitoring; stable chronic acidosis is corrected orally and gradually.
C. Switch to an acidifying diet to prevent uroliths
An acidifying diet would worsen the acidosis; renal diets are precisely alkalinising.
D. Oral alkalinising agent (potassium citrate or sodium bicarbonate) to keep bicarbonate at 18–24 mmol/L, with rechecks
Correct. If bicarbonate remains low despite the renal diet, IRIS recommends oral supplementation. Potassium citrate also provides potassium (useful if hypokalaemia tends to occur); monitor potassium, especially with an ACE inhibitor or ARB.
lightbulb Key takeaway
IRIS bicarbonate target: 18–24 mmol/L in dogs and 16–24 mmol/L in cats. Measure it with the patient stable and after a few weeks on the renal diet, which already alkalinises; supplement only if it remains low.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.