A number of studies have documented a U-shaped association between serum predialysis bicarbonate concentration and mortality rate among patients undergoing chronic hemodialysis, suggesting that overdosing alkali therapy may be hazardous .
Qureshi, "The use of alkali therapy in severe diabetic ketoacidosis.," Diabetes Care, vol.
Madias, "Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review," American Journal of Nephrology, vol.
Correction of metabolic acidosis with alkali therapy
increases appetite, decreases protein degradation, and increases lean body mass, and is recommended when serum bicarbonate levels fall below 22 mmol/L (Kovacic, Roguljic, & Kovacic, 2003).