A 52-year-old man with chronic kidney disease stage 4 presents with fatigue and dyspnea. Arterial blood gas shows pH 7.28, PaCO₂ 32 mmHg, HCO₃⁻ 14 mEq/L, and PaO₂ 88 mmHg. What is the most common cause of this acid-base disturbance in CKD patients?

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