To the Editor: The mini-review on bicarbonate therapy for prevention of chronic kidney disease progression1 was a much-needed, well-written, and informative review. It has long been known that chronic acidosis seen in chronic kidney disease (CKD) 4 and 5 has a deleterious effect on digestion and general nutrition. The recommendation of rigorous treatment to prevent progression of CKD was well explained by various recently reported pathophysiological mechanisms that support the urgency of treatment. However, there was a recommendation in the management that is a cause of concern. Because of the probability of poor compliance and intolerance with administration of NaHCO3 compounds, the authors recommend other alkali products—e.g., Shohl’s solution (sodium citrate and citric acid) or polycitra (citric acid, potassium citrate, and sodium citrate)—as alternatives. They do issue a warning of the dangers of increased aluminum (Al) absorption in patients taking Al-containing phosphate binders but did not elaborate on this point. We showed that ingestion of a low dose of citrate contained in a well-known effervescent calcium supplement taken by normal volunteers as well as subjects with stable chronic renal failure resulted in an increase in the excretion of urinary Al in normal individuals and an increase in both serum and urine Al in those with CKD.2 The experiments showing this were accompanied by a low dose of Al hydroxide supplementation. The point of the research, however, was to alert medical practitioners that, even without Al supplementation, patients with CKD 3b, 4, and 5 may experience an increase in serum and urine Al if receiving compounds containing citrate. This is because all foodstuffs in a powdery form contain Al to prevent them from congealing, as AL has hydrophobic properties. For this reason we believe that all citrate-containing preparations are totally contraindicated because of the Al contained in, e.g., flour, custard powder, salt, sugar, etc. Although the bicarbonate powder may occasionally be unpleasant to take, it is safe and inexpensive, and the unpleasant taste can be disguised.