progressing to kidney failure. however, side effects of oral alkali therapy include gastrointestinal intolerance, worsening edema, and worsening hypertension. furthermore, large doses of oral alkali are required to treat chronic metabolic acidosis, and the pill burden can limit adherence. veverimer (trc 101) is a promising investigational drug designed to treat metabolic acidosis by binding with the acid in the gastrointestinal tract and removing it from the body through excretion in the feces, in turn decreasing the amount of acid in the body, and increasing the level of bicarbonate in the blood. results from a phase 3, double-blind placebo-controlled 12-week clinical trial in people with ckd and metabolic acidosis demonstrated that veverimer effectively and safely corrected metabolic acidosis in the short-term, and a blinded, placebo-controlled, 40-week extension of the trial assessing long-term safety, demonstrated sustained improvements in physical function and a combined endpoint of death, dialysis, or 50% decline in egfr.