Impact of Dialysis Modality and Acidosis on Nutritional Status

Dumler, Francis; Falla, Pedro; Butler, Regina B.; Wagner, Colleen; Francisco, Kathryn

doi:10.1097/00002480-199909000-00009

Cited by 15 publications

(14 citation statements)

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“…Other factors affecting ABB in PD patients not taken account of by Henderson-Hasselbalch or Stewart-Fencl principle include, in particular, protein catabolic rate, transport characteristics of the peritoneal membrane, and the type of phosphate binders. Unlike some earlier studies, [41][42][43] we did not demonstrate a correlation between protein catabolic rate and serum bicarbonate. Peritoneal transport characteristics no doubt affect transperitoneal base transport.…”

Section: Discussioncontrasting

confidence: 99%

“…[6][7][8][9][10][11] Though in hemodialysis (HD) patients, both high and low serum bicarbonate levels are associated with an increased risk for mortality and hospitalization, [12] mild acidosis appears to be associated with a better outcome in PD patients. [13,14] The cause of metabolic acidosis in chronic renal failure has been thought to be an inability to excrete non-volatile acids in the face of reduced renal bicarbonate synthesis (i.e., acidosis with an increased anion gap, AG). [15][16][17] However, recent studies have suggested that other mechanisms may be also involved in its etiopathogenesis.…”

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confidence: 99%

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Acid-Base Balance in Peritoneal Dialysis Patients: A Stewart-Fencl Analysis

et al. 2009

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Background. Evaluation of acid-base disorders using the Stewart-Fencl principle is based on assessment of independent factors: strong ion difference (SID) and the total concentration of non-volatile weak acids (Atot). This approach allows for a more detailed evaluation of the cause of acid-base imbalance than the conventional bicarbonate-centered approach based on the HendersonHasselbalch principle, which is a necessary yet insufficient condition to describe the state of the system. The aim of our study was to assess acid-base disorders in peritoneal dialysis (PD) patients using both of these principles. Methods. A total of 17 patients with chronic renal failure (10 men), aged 60.7 (22-84) years, treated by PD for 25.7 (1-147) months were examined. A control group included 17 healthy volunteers (HV) (8 males), with a mean age of 42.7 (22-77) years and normal renal function. Patients were treated with a solution containing bicarbonate (25 mmol/L) and lactate (15 mmol/L) as buffers; eleven of them used, during the nighttime dwell, a solution with icodextrin buffered by lactate at a concentration of 40 mmol/L. The following equations were employed for calculations of acid-base parameters according to the Stewart-Fencl principle. The first is SID = [Na + ] + [K

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confidence: 99%

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confidence: 99%

Acid-Base Balance in Peritoneal Dialysis Patients: A Stewart-Fencl Analysis

et al. 2009

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“…As previously reported, patients with lower dietary protein intakes were also found to have higher serum bicarbonate concentrations. 22 Of note, serum sodium and chloride concentrations were also lower in Results are presented as mean Ϯ SD and percentages. BMI, body mass index.…”

Section: Discussionmentioning

confidence: 98%

Hypoalbuminemia is a Marker of Overhydration in Chronic Maintenance Patients on Dialysis

Dumler

2003

ASAIO Journal

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Hypoalbuminemia is an important risk factor for increased morbidity and mortality in patients on dialysis. Hypoalbuminemia is usually attributed to malnutrition or a state of chronic inflammation. However, hypoalbuminemia could result from hemodilution caused by chronic volume expansion. We prospectively evaluated 142 patients on chronic dialysis for 12 consecutive months (mean age: 62 +/- 14 years; 41% women, 37% African American, 43% diabetic, 27% peritoneal dialysis). Intracellular (ICW) and extracellular (ECW) water content was estimated using single frequency bioelectrical impedance. Values in each albumin grouping (group 1, < 3.5 g/dl; group 2, 3.5-4.0 g/dl; group 3, > 4.1 g/dl) are expressed as annual mean +/- SEM. Group 1 patients had lower body weight, body mass index, blood urea nitrogen, serum creatinine, dietary protein intake, and ICW content than those in groups 2 and 3. ECW was significantly increased in group 1 when compared with groups 2 and 3 (p < 0.001). A significant correlation was found between ECW and serum albumin concentration (R = 0.2230; p < 0.0001). Resistance and reactance were decreased in group 1 when compared with groups 2 and 3 (p < 0.05 and 0.001, respectively), causing the resultant bioimpedance vector to move away from the normal population range into the overhydration boundaries. We conclude that, in addition to malnutrition and chronic inflammation, overhydration is a contributor to hypoalbuminemia in patients on chronic dialysis.

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“…However, recent studies suggest that there might be a reverse epidemiology in the impact of acidosis on patient outcome in peritoneal dialysis patients [23][24][25][26] . Mild acidosis was found to be associated with better outcome.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis in Peritoneal Dialysis Patients: The Role of Residual Renal Function

Tian

Shan²,

Xu³

et al. 2005

Blood Purif

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Background: Metabolic acidosis (MA) is common in chronic renal insufficiency (CRI) patients, and its pattern changes as renal function deteriorates. Although the prevalence of acidosis in peritoneal dialysis has been reported to be rather high, the causes of it have not been well studied. The present study was performed to examine the prevalence of metabolic acidosis in our continuous ambulatory peritoneal dialysis (CAPD) patients and its possible causes. Methods: In this cross-sectional study, we analyzed data from patients who received maintenance CAPD in our hospital and had been on dialysis for at least one month. Patients’ demographic features, medications, and intercurrent medical conditions were recorded. Data including blood biochemistry, dialysis adequacy, and nutrition were collected. A serum bicarbonate concentration of less than 23 mmol/l was defined as having acidosis. The normal value of the serum anion gap (AG) was defined as 12 ± 4 mmol/l. Results: A total of 154 patients (76 males and 78 females) with age of 60.04 ± 13.92 years and the time on dialysis of 16.83 ± 21.59 months were included in this study. Sixty-six patients (43%) had a serum bicarbonate of less than 23 mmol/l, among whom 12 patients (8%) were identified as having MA with increased AG, 54 (35%) were identified as having MA with normal AG. Patients who had better residual renal function (RRF) had a significantly lower serum bicarbonate level despite their higher total KT/V_urea as compared to those with lower RRF. In addition, patients with MA and normal AG had the highest RRF and highest total KT/V_urea. All patients with MA and increased AG had significantly lower values of dietary protein intake (DPI) as compared to their values of normalized protein nitrogen appearance (nPNA), and had higher serum urea and phosphate levels as compared with those patients without MA. Conclusion: Our study suggested that CAPD patients with better RRF were more susceptible to metabolic acidosis, which was characterized by normal anion gap and hyperchloremia. Thus, we speculate that renal loss of bicarbonate may to a large extent be responsible for the occurrence of MA in these patients.

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Impact of Dialysis Modality and Acidosis on Nutritional Status

Cited by 15 publications

References 0 publications

Acid-Base Balance in Peritoneal Dialysis Patients: A Stewart-Fencl Analysis

Acid-Base Balance in Peritoneal Dialysis Patients: A Stewart-Fencl Analysis

Hypoalbuminemia is a Marker of Overhydration in Chronic Maintenance Patients on Dialysis

Metabolic Acidosis in Peritoneal Dialysis Patients: The Role of Residual Renal Function

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