A new study from Japan has revealed a surprising gap in the routine care of people with chronic kidney disease. Researchers found that a simple and low-cost blood test is rarely used, which means an important health problem often goes unnoticed and untreated.
The study was published in the journal Scientific Reports and highlights an issue that may affect patients not only in Japan but around the world.
Chronic kidney disease, often called CKD, is a long-term condition where the kidneys slowly lose their ability to work properly. The kidneys play a key role in filtering waste and extra fluid from the blood.
When they do not function well, harmful substances can build up in the body. CKD is common, especially in older adults, and can lead to serious complications such as heart disease, bone problems, and eventually kidney failure.
One common but often overlooked complication of CKD is a condition called metabolic acidosis. This happens when there is too much acid in the body. Normally, the kidneys help keep acid levels balanced, but when kidney function declines, this balance can be lost.
Metabolic acidosis can have serious effects on health. It has been linked to muscle loss, weaker bones, insulin resistance, faster worsening of kidney disease, and even a higher risk of death. Because of these risks, medical guidelines recommend checking for this condition and treating it when needed.
Doctors can detect metabolic acidosis by measuring the level of a substance called bicarbonate in the blood. If the level falls below a certain point, usually 22 mEq/L, treatment is recommended. This treatment may include simple steps such as taking bicarbonate supplements or making dietary changes.
Despite this, the new study found that bicarbonate levels are rarely checked in routine care. The research team, led by Mai Tanaka, analyzed data from more than 21 university hospitals across Japan. They looked at patients with moderate stages of CKD between 2014 and 2021.
The results showed that fewer than 10 percent of patients had their bicarbonate levels measured each year. This means that in most cases, doctors did not have the information needed to detect metabolic acidosis.
Because testing was so uncommon, the overall number of patients diagnosed with metabolic acidosis appeared low.
However, when researchers focused only on the patients who were actually tested, they found a very different picture. Nearly half of these patients had metabolic acidosis, and the problem became more common as kidney disease progressed.
Even more concerning was the gap between detection and treatment. Among patients who had low bicarbonate levels, only a small number were formally diagnosed, and even fewer received treatment. This suggests that many patients may not be getting the care they need.
The study also points out that this issue is not limited to Japan. Similar research in North America has shown that metabolic acidosis is often underdiagnosed and undertreated there as well. Many patients do not receive treatment even when they meet the criteria.
Scientists believe that excess acid in the body can speed up kidney damage by causing inflammation and scarring in kidney tissue. Diet may also play a role, as some foods increase the body’s acid load.
The surprising part is that testing bicarbonate levels is simple, cheap, and widely available. The main problem seems to be that it is not routinely included in standard care for CKD patients.
This means there is a clear opportunity to improve care. By adding this simple test to regular check-ups, doctors may be able to detect metabolic acidosis earlier and start treatment sooner. This could help slow the progression of kidney disease and improve overall health.
The findings also highlight a broader issue in healthcare. Sometimes, important conditions are missed not because they are rare, but because they are not actively looked for. In this case, metabolic acidosis may be “hidden in plain sight.”
From a clinical perspective, this study suggests that healthcare systems should review their current practices and consider making bicarbonate testing a routine part of CKD care. For patients, it also shows the importance of regular monitoring and asking questions about test results.
However, it is important to note that this study is based on real-world data and cannot prove cause and effect. It shows patterns in care rather than controlled outcomes. Still, the large number of patients and consistent findings make the results meaningful.
Overall, this research highlights a simple but powerful message. A low-cost test that is already available could help identify a serious problem earlier and lead to better treatment. Improving awareness among doctors and healthcare systems may be the key to closing this gap and improving outcomes for people with chronic kidney disease.
If you care about kidney health, please read studies about how to protect your kidneys from diabetes, and drinking coffee could help reduce risk of kidney injury.
For more information about kidney health, please see recent studies about foods that may prevent recurrence of kidney stones, and eating nuts linked to lower risk of chronic kidney disease and death.
The research findings can be found in Scientific Reports.
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