Acid-base balance is a cornerstone of homeostasis. Its disturbance in chronic kidney disease contributes not just to biochemical abnormalities but to real-world morbidity, including bone disease, muscle wasting, and accelerated renal decline. Session participants will explore the physiology of acid-base regulation, understand how CKD disrupts this equilibrium, and learn the clinical strategies to diagnose, manage, and monitor metabolic acidosis in CKD—from standard alkali therapies to emerging dietary and pharmacologic innovations.