Moderate Metabolic Acidosis and Its Effects on Serum Parameters in Hemodialysis Patients

Abstract

We screened the laboratory data of 50 chronic hemodialysis patients selected randomly over a 21-month period to generate 158 data points which identified two groups: (1) those with a predialysis total CO₂ concentration less than or equal to 19 mEq/l (data A; n = 57) and (2) those with a predialysis total CO₂ concentration greater than 19 mEq/l (data B; n = 101). Then, both groups were compared for the following parameters: predialysis blood urea nitrogen (BUN), serum phosphorus, uric acid, creatinine, and albumin concentrations, Kt/V, urea reduction ratio, normalized protein catabolic rate, dry weight, ultrafiltration, blood flow and dialysis flow rates, duration of dialysis treatment, and blood pressure. Group data A had significantly higher predialysis BUN, phosphorus, and uric acid concentrations than group data B. There were significant inverse correlations between predialysis serum bicarbonate and predialysis BUN, phosphorus, and uric acid concentrations. Although it is not clear what the long term side effects of moderate metabolic acidosis are, we recommend its correction.

Correction of Acidosis by Hemodialysis: Proposal of a Correlation with Urea Kinetics

“…Their study suggested that persistent acidosis, observed despite standard bicarbonate dialysis, was caused by a high dietary protein intake which resulted in an increased acid load. In our group of patients, however, we could not observe this correlation, in agreement with the study by Gao et al [2], although with a much smaller number of patients in our studies. Also, the quantity of dialysis, measured by URR, did not correlate with the degree of acidosis during the pre-dialysis period, nor did the increment in URR in 7 patients individually alter subsequent bicarbonate measurements made before dialysis.…”

“…For patients on HD, the highest level of total body acid load is found during the period immediately before HD, and is generated from protein nutrition and accumulated with variable intensity. The treatment of acidosis by HD has received diverse considerations [1][2][3]. Some studies show that increasing the dialysate bicarbonate concentration may decrease the degree of acidosis before HD and improve nutritional status [4,5], although in one study there was no alteration in Leite/Leal/Cardoso nutritional parameters [6].…”

Are Target Serum Bicarbonate Levels Achieved in Maintenance Hemodialysis Patients: A Single Centre Experience

“…Total protein, serum albumin, uric acid and serum phosphorus can be used as markers of better nutrition. As in previous studies by Gao et al 5 and Leavey et al 6 , we also noted an inverse correlation between BMI, total protein, serum phosphorus, serum uric acid and serum ferritin levels. This suggests that a higher protein intake may lead to a lower serum bicarbonate at the start of the subsequent dialysis session.A higherpredialysisserum bicarbonate level may be a surrogate of inadequate dietary protein intake 7 .…”

Metabolic Acidosis of Chronically Hemodialyzed Patients

“…Gao et al [40]demonstrated that higher predialysis serum bicarbonate (predialysis total CO 2 concentration >19 mmol/l) significantly improves predialysis BUN, phosphorus, and uric acid concentrations. Graham et al [41]demonstrated better leucine turnover with correction of acidosis.…”