《慢性肾脏病患者代谢性酸中毒诊治中国专家共识》(简称本共识)基于我国慢性肾脏病(chronic kidney disease，CKD)患者代谢性酸中毒(metabolic acidosis，MA)高发且管理策略亟待规范的临床现状，由中国医院协会血液净化中心分会牵头多学科专家制定。共识系统阐述了MA作为CKD进展、肌肉骨骼消耗及不良预后独立危险因素的核心机制，创新性引入“亚临床MA”概念，为早期干预提供理论依据。共识构建了以优化膳食净酸负荷为源头、以精准的血清碳酸氢根监测阶梯为路径、以“宁酸勿碱”为原则的个体化治疗策略，并强调血液净化人群中综合容量控制、营养评估及透析液缓冲液处方调整的多维管理。据此，共识提出了涵盖早期筛查、诊断评估与综合干预的系列推荐意见，旨在为临床医师构建规范、系统的管理框架，以期延缓慢病进程并改善患者远期预后。

This consensus, developed by multidisciplinary experts led by the Blood Purification Center Branch of the Chinese Hospital Association, addresses the high prevalence of metabolic acidosis (MA) in Chinese patients with chronic kidney disease (CKD) and the urgent need to standardize its management. It systematically elucidates the core mechanisms by which MA acts as an independent risk factor for CKD progression, musculoskeletal wasting, and adverse outcomes, and innovatively introduces the concept of “subclinical MA”, which provides a theoretical basis for early intervention. The consensus establishes an individualized alkali therapy strategy derived from optimizing dietary net acid load, follows a precise stepwise monitoring pathway of serum bicarbonate, and adheres to the principle of “prefer mild acidosis to excessive alkalization” (i.e., favoring a mildly acidotic state over overcorrection). It further emphasizes multidimensional management for patients receiving blood purification, encompassing comprehensive volume control, nutritional assessment, and tailored adjustment of dialysate buffer prescriptions. Accordingly, the consensus puts forward a series of recommendations covering early screening, diagnostic evaluation, and integrated interventions, aiming to equip clinicians with a standardized and systematic management framework to delay disease progression and improve patients’ long-term outcomes.