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.