Bone in CKD Alkali Response (BICARb Pilot Trial)

Exclusion Criteria

• •Baseline potassium ≥ 5.5 mEq/L or prior history of hyperkalemia in the last 6 months (potassium \> 5.5 mEq/L) or currently taking a potassium lowering agent
• •Alkali therapy within the prior 12 months
• •Baseline ECG with abnormalities associated with increased risk of arrythmia, excluding left ventricular hypertrophy
• •Baseline serum bicarbonate levels \< 17 or ≥ 30 mEq/L
• •Serum calcium \< 8.6 mg/dL, adjusted for serum albumin
• •Significant comorbidity causing acid-base imbalance (e.g., active cancer requiring chemotherapy, chronic liver failure, moderate or severe chronic obstructive lung disease, New York Heart Association class 2 or greater congestive heart failure, obstructive sleep apnea requiring nightly continuous positive airway pressure, active glomerular disease requiring immunosuppressive therapy, intestinal malabsorption or celiac disease)
• •Plans to relocate out of the area in the next 3 months
• •Urine pH \> 8 or history of nephrolithiasis
• •Lower extremity amputations or non-ambulatory
• •Metabolic bone disease not related to CKD (e.g., Paget's disease, primary hyperparathyroidism)
• •Endocrinopathy: untreated hyper or hypothyroidism, Cushing's syndrome
• •Medical diseases that can affect therapy (severe myocardial damage, acute dehydration, delayed gastric emptying, esophageal compression, or intestinal obstruction or stricture)
• •Use of bisphosphonates, denosumab, teriparatide, abaloparatide, romosozumab, raloxifene, estrogen or testosterone replacement therapy, or an unstable dose of glucocorticoids within the 12-months prior to enrollment
• •Previous bilateral wrist and tibia fractures
• •Solid or liquid organ transplant
• •On dialysis or with rapidly deteriorating kidney function or expectation for transplantation or initiation of dialysis in less than 3 months
• •Pregnancy or breastfeeding
• •Prisoners or institutionalized individuals
• •Unwillingness to provide informed consent