Is treatment of metabolic acidosis an effective strategy for slowing chronic kidney disease (CKD) progression?

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.: Is treatment of metabolic acidosis an effective strategy for slowing chronic kidney disease (CKD) progression?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.): no
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.): Adults with CKD
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.): The elderly, obese, African-Americans, disparity populations
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.): Estimated glomerular filtration rate (eGFR), serum creatinine, cystatin C, albuminuria, other measurements of kidney disease status, progression
Describe any health-related risks, side effects, or harms that you are concerned about.: Any harms from treatment

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

AHRQ Priority Populations

Low income groups
Minority groups
Women
Elderly
Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

Describe why this topic is important.: CKD is a significant public health problem affecting more than 30 million adults in the United States, who are at increased risk of hospitalization, cardiovascular disease, end-stage renal disease (ESRD), and death. Metabolic acidosis is one of the complications associated with CKD. In addition to contributing to bone disease and muscle wasting, as well as having adverse effects on hormones and functional status, metabolic acidosis has also been thought to contribute to progression of CKD.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.): This topic was identified in our AHRQ/EHC sponsored topic identification project. Among a large number of CKD topics, a group of stakeholders ranked this as a high priority topic.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.): yes
If yes, please explain:: Alkali therapy has been shown to slow CKD progression in several animal studies. However, the effectiveness of treating metabolic acidosis in slowing down the progression of CKD in humans is unknown.

How will an answer to your research question be used or help inform decisions for you or your group?: Convincing evidence on effective weight interventions will potentially change guidelines and practice.
Describe the timeframe in which an answer to your question is needed.: No particular timeframe, rather CKD is an ongoing and increasing problem for society.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.: CKD has a higher prevalence among African Americans, Hispanics, and elderly people, disparity populations with poor access and underutilization, lower economic and educational status, and inner city and some rural populations.

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate): Convincing evidence on effective weight interventions will potentially change guidelines and practice.

Are you making a suggestion as an individual or on behalf of an organization?: Organization

Effective Health Care Program