Influence of medications containing acid salts on serum bicarbonate in CKD

Background: Many medications are formulated with acid salts. Their impact on acid-base balance in chronic kidney disease (CKD) is unclear. Methods: We calculated the acid load (meq/d) from medications prescribed to 74 US veterans with diabetes and CKD to identify agents with high potential acid load. We also determined cross-sectional associations between the acid load from medications and acid-base parameters after adjusting for demographics, estimated glomerular filtration rate (eGFR), protein intake, and other confounders. Results: Thirty-one of 125 (25%) medications prescribed contained an acid salt. Metformin hydrochloride (15.4 meq/d at 2550 mg/d) and gabapentin hydrochloride (13.0 meq/d at 2700 mg/d) were identified as agents with a high potential acid load. Mean daily acid load from medications was 6.6 meq/d in the overall cohort, 14.2 meq/d in the high medication acid load group (≥7.7 meq/d, n=29), and 1.6 meq/d in the low medication acid load group (