I'm usually so wrapped up in looking at lab results for creatinine, potassium, phosphorus, calcium, etc., I realized that I know very, very little about metabolic acidosis and bicarb levels. I read the article, and it certainly looks like there could be some great benefits to treating acidosis with alkali supplements - not just for addressing complications but perhaps in slowing progression? I tried to find some articles that were recent, hoping that more had been discovered since 2012. One that might be of interest can be found here:
http://jasn.asnjournals.org/content/26/3/515.full(Free PDF download is available on the site - it's a bit over 500KB, so I didn't know whether to upload it here??)
From the early 2015 article abstract:
This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications.
And the concluding paragraph:
The optimal desired serum bicarbonate level, dose, and time of initiation of alkali-based therapy in CKD is yet to be determined. It seems that a level between 24 and 26 mEq/L correlates with the best clinical outcomes, but this requires proper validation. The range of potential benefits including not only mitigation of renal injury but also protection of other organ systems routinely damaged in the course of CKD support efforts to test alkalinization in clinical trials. Several clinical trials are underway to further test the value of bicarbonate supplementation.