Beyond bicarbonate: complete acid–base assessment in patients receiving intermittent hemodialysis

Marano, Marco; Maranò, Stefano; Gennari, F. John

doi:10.1093/ndt/gfw022

Cited by 25 publications

(52 citation statements)

References 10 publications

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“…Aside from the typical limitations of observational studies, we did not have pH measurements as recommended by some to get a complete acid-base picture on our participants [27]. This information would have been appropriate and could have allowed us to better characterize the degree of post-dialysis alkalosis and its potential to induce an arrhythmia, since severe alkalemia (pH > 7.6) predisposes a patient to refractory supraventricular and ventricular arrhythmias [28].…”

Section: Discussionmentioning

confidence: 99%

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

et al. 2019

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Background: The etiology of sudden cardiac death in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is largely unknown, though there is evidence to suggest that metabolic alkalosis induced by HD with a high-bicarbonate dialysate/prescription may play a role. Methods: We investigated the effects of metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate on frequency of ventricular arrhythmia in 47 patients with ESRD on chronic HD using 48-h Holter monitoring in 3 phases: intra-HD, post-HD day 1, and post-HD day 2. Serum levels of bicarbonate, calcium, and potassium along with hemodynamics were measured pre-HD, post-HD, 20-h post-HD, and 44-h post-HD. Correlations were performed to verify the association between bicarbonate prescription and change in serum bicarbonate levels post-HD and to determine if the HD-induced change in serum bicarbonate level (metabolic alkalosis) had any direct association with ambient ventricular arrhythmia (premature ventricular contractions per hour) or indirect associations with ambient ventricular arrhythmia by affecting electrolytes or hemodynamics that are known to increase the risk of ventricular arrhythmia. Results: Mean pre-HD serum bicarbonate level was 21.3 mEq/L. Dialysate bicarbonate prescription (mean of 36.4 mEq/L) correlated with changes in serum bicarbonate levels immediately post-HD 26.7 mEq/L (r = 0.46, p < 0.01), 20-h post-HD 25.2 mEq/L (r = 0.38), and 44-h post-HD 23.2 mEq/L (r = 0.35, p = 0.01). No statistically significant correlations were found between the post-HD change in serum bicarbonate levels (metabolic alkalosis) with ambient ventricular arrhythmia, changes in serum calcium, potassium, or hemodynamics in any phase. Conclusions: High-bicarbonate dialysate prescription is associated with metabolic alkalosis following the HD procedure. A mild metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate solution had no direct association with ambient ventricular arrhythmia on Holter monitoring and was not associated with changes in hemodynamics or changes in serum total calcium or potassium levels. This study helps to provide guidance for the safe use of high bicarbonate dialysate/prescription in patients with ESRD on HD.

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Section: Discussionmentioning

confidence: 99%

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

et al. 2019

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“…blood returning to the patient [2][3][4]8] . This hypercapnia lowers pH despite high bicarbonate concentration but without hypoxia, unless lung disease coexists.…”

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confidence: 99%

“…If the patient is unable to breath away the CO 2 added from the dialysate ( fig. 1b), then hypercapnic acidosis will occur or be exacerbated [2,4] . In such a case, the label 'acidosis by dialysate' should be used because the mixed acidosis found in the arteDear Editor, During hemodialysis, the arterial line of the extracorporeal circuit allows for easy access to arterial blood sampling [1] , but may return unexpected findings.…”

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confidence: 99%

“…There is another circumstance of hypercapnia featured by normal oxygenation and lung function. This non-hypoxic hypercapnic acidemia may be called 'dialysisrelated acidemia' [2][3][4] .…”

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confidence: 99%

“…Decreased myocardial contractility and vasodilatation secondary to hypercapnia may be clinically evident. Most notably, the symptoms should disappear (slowly) by simply stopping dialysate flow [4,10] . The usual acid-base pattern is mixed metabolic and respiratory acidosis with severe fall in pH and hypoxia.…”

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confidence: 99%

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