Clinical Research Directory

Inclusion Criteria: * Moderate-severe CKD determined by eGFR \<50ml/min per 1.73m2 by CKD EPI equation on at least 2 consecutive occasions. * Metabolic acidosis defined as bicarbonate level\<24 on two consecutive occasions. Bicarbonate level of 24 or less allowed if eGFR\<=45ml/min per 1.73m2 * Age 21 to 85 years old Exclusion Criteria: * Type 1 diabetes * Poorly controlled diabetes (HgbA1c\>10%) * History of persistent hyperkalemia (K\>5.4) * History of persistent hypokalemia (K\<3.3) * Uncontrolled blood pressure (\>170/100) * Chronic treatment with renal replacement therapy * History of aortic dissection or severe valvular heart disease * Exercise induced angina * Uncontrolled cardiac dysrhythmia * Oxygen dependent chronic obstructive pulmonary disease (COPD) * Symptomatic claudication * End stage liver disease * Mobility disability defined as inability to walk without human assistance * Dementia or psychosis * Patients who cannot consent * Active use of intraveneous drugs * Non-english speaking * History of transplant * Implants that prohibit MRI measurements or trauma involving metal fragments * Pacemaker * Expectation to start dialysis during the course of study. * Women who are breastfeeding, pregnant, or are wanting to become pregnant * Any condition which in the judgement of the clinical investigator places the participant at risk from participation in the study. Exclusion criteria for optional muscle biopsy * Drugs- anticoagulants or antiplatelets: * Anticoagulants, any 1 (coumadin, rivaroxaban, apixaban, dabigatran, edoxaban) * Antiplatelets, any 2 (aspirin, cilostazol, clopidogrel, dipyridamole, prasugrel, ticragrelor, ticlopidine, vorapaxar) * Platelet count \<100,000 * International normalized ratio (INR)\>1.4