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Hi Manuel,

Regarding AI in general, there seem to be many reports on the internet discussing the reliability of AI reports. Personally I feel more comfortable with actual studies in people or at least animals to use as guides. As an example, I asked an AI a question regarding Parkinson's disease and then asked the same the very next day and the two answers were not the same. I understand that as the science evolves that AI should be constantly updating their data, but this seems like it would only happen after at least a month has passed, not the very next day!

As I said, in my opinion, your magnesium level seems high and significantly lowering the dose seems appropriate. Perhaps take a break from oral magnesium citrate and switch to magnesium chloride spray (mag oil) applied topically over the kidney areas front and back each day to try and target the kidney area. Mag oil ultimately goes systemic anyway.

Since you are at an advanced stage of CKD (stage 4), determining a proper dose of sodium bicarbonate will have to be determined by your doctor because regular monitoring will be needed. They will first have to determine if your bicarbonate level is normal and determine dosing accordingly from there. Here is a human study link to show to your doctor so that your doctor can understand that sodium bicarbonate has health value for your kidneys and also to give a starting guide in terms of dosage :

https://pmc.ncbi.nlm.nih.gov/articles/PMC11843131/

Here is a relevant quote from the human study :

' In this randomized, interventional 3-arm trial of participants with macroalbuminuric, primary hypertension-associated CKD and normal eGFR, dietary acid reduction over 5 years with either F&Vs or NaHCO₃ (HCO₃⁻) yielded improved (i.e., less acid) systemic acid-base status. Improvement was manifest by parameters not usually assessed clinically, including less acid accumulation and greater urine citrate excretion (8-hour UcitV). Improved acid-base status was also manifest by parameters assessed clinically, including higher levels of PTCO₂, PHCO₃⁻, and PCO₂. The 2 intervention groups had lower UNAE excretion than UC, consistent with a reduced acid challenge. Furthermore, improved acid-base status was associated with less oxidative stress assessed by lower U8-iso excretion, and less kidney injury assessed by lower UACR, urine N-acetyl-β-D-glucosamine, and urine angiotensinogen excretion. Indeed, both intervention groups had higher eGFR at 5 years than UC. These data show that typical modern diets, largely acid-producing, ⁴ can cause sustained acid accumulation in those with normal eGFR, similar to patients with CKD and reduced eGFR. In addition, this acid accumulation can be reduced by less acid-producing foods or by mineral alkali like NaHCO₃; both interventions were associated with less kidney injury. '

The graphs in the above study link are very revealing and may be what it takes to show your doctor the usefulness of using sodium bicarbonate long term as this was a 5 year study.

As to the 9 mg of melatonin, in studies melatonin starts to show benefits for humans at 1/2 (.5 mg) a milligram. In your case though, you are apparently tolerating the 9 mg/day dose well so far. Your doctor will have to decide if a further increase in dose will be good or not because it will also have to be compatible with other meds you may be taking. Pretty much all supplements and their dosing will need to be approved by your doctor since you are in stage 4 CKD.

Do you have hypertension? You didn't mention if the cause of your CKD is known. If you do have hypertension and are on a specific hypertension med, you might ask your doctor if you can switch to Beet Root Powder Capsules (BRPC) as these can lower blood pressure while potentially offering benefits for the kidneys at the same time. I like when a single supplement can have multiple uses.

As to other supplements to consider for CKD, the three supplements I mentioned are a good place to start since your doctor will need to approve and supervise them and I think these three may have a better chance of meeting your doctor's approval and will probably be at the supplement limit for your doctor in number. Again, those three at label dosing are :

Blueberry Extract

Stinging Nettle

Silymarin

These three are quite potent and likely to have synergy due to varying methods of action in CKD. All three have very good safety profiles which your doctor should check and is especially important in your case.

Art