A dangerous gap in chronic kidney disease care has emerged from Japan's national registry, where a treatable complication affecting nearly half of patients goes largely undetected. This oversight could accelerate kidney decline and increase cardiovascular risks for millions of Asian adults with moderate kidney impairment.
Analysis of the Japan Chronic Kidney Disease Database revealed that serum bicarbonate testing—essential for detecting metabolic acidosis—occurred in fewer than 10% of patients annually between 2014 and 2021. Among the 44.2% of tested patients who showed acidosis (bicarbonate levels below 22 mEq/L), only 8.6% received proper diagnosis codes and merely 7.5% received sodium bicarbonate treatment. This represents a 92% underdiagnosis rate for a condition affecting roughly 44,000 patients in the registry.
The findings challenge assumptions about healthcare quality in developed nations and suggest systematic care gaps may be more widespread than Western studies indicate. Metabolic acidosis accelerates kidney function decline, increases bone disease risk, and contributes to muscle wasting—all preventable with simple bicarbonate supplementation. The low testing rates point to either inadequate clinical protocols or insufficient awareness among nephrologists about guideline recommendations.
This represents the largest Asian registry analysis of acidosis management in kidney disease, filling a crucial evidence gap. The undertreatment rates mirror concerning patterns seen in European and North American studies, suggesting global systematic failures in implementing established kidney care standards. For the estimated 850 million people worldwide with chronic kidney disease, these findings underscore urgent needs for improved screening protocols and clinical decision support systems.