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Acid-base disorders associated with serum electrolyte patterns in patients on hemodiafiltration
J. Havlin, O. Schück, J. Charvat, K. Slaby, M. Horackova, J. Klaboch, M. Sagova, S. Vankova, K. Matousovic,
Jazyk angličtina Země Francie
Typ dokumentu časopisecké články
- MeSH
- chronické selhání ledvin komplikace terapie MeSH
- elektrolyty krev MeSH
- hemodiafiltrace škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- poruchy acidobazické rovnováhy etiologie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Metabolic acidosis (MAC) is a common aspect of dialysis-dependent patients. It is definitely caused by acid retention; however, the influence of other plasma ions is unclear. Understanding the mechanism of MAC and its correction is important when choosing the dialysis solution. Therefore, we assessed the relationship between intradialytic change of acid-base status and serum electrolytes. METHODS: We studied 68 patients on post-dilution hemodiafiltration, using dialysate bicarbonate concentration 32mmol/L. The acid-base disorders were evaluated by the traditional Siggaard-Anderson and modern Stewart approaches. RESULTS: The mean pre-dialysis pH was 7.38, standard base excess (SBE) -1.5, undetermined anions (UA(-)) 7.5, sodium-chloride difference (Diff(NaCl)) 36.2mmol/L. MAC was present in 34% of patients, of which 83% had an increased UA(-) as a major cause of MAC. The mean nPCR was 0.99g/kg/day and correlated negatively with SBE. After dialysis, metabolic alkalosis predominated in 81%. The mean post-dialysis pH was 7.45, SBE 4, UA(-) 2.6, Diff(NaCl) 36.9mmol/L. ΔSBE significantly correlated with ΔUA(-), but not with ΔDiff(NaCl) or ΔCl(-). CONCLUSIONS: MAC in patients on hemodiafiltration is mainly caused by acid retention and is associated with higher protein intake. We did not prove the effect of sodium or chloride on acid-base balance. Even though we used a relatively low concentration of dialysate bicarbonate, we recorded a high proportion of post-dialysis alkalosis caused by the excessive decrease of undetermined anions, which had been completely replaced by bicarbonate and indicated the elimination of undesirable anions, as well as of normal endogenous anions.
B Braun Avitum Praha Nusle Dialysis Center Táborská 325 57 140 00 Prague 4 Czech Republic
Fresenius medical care DS Dialysis centre Motol Prague Czech Republic
Citace poskytuje Crossref.org
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- $a Havlin, Jan $u Department of medicine, 2nd Medical Faculty of Charles University and Faculty hospital Motol, V Úvalu 84, 150 06, Prague 5, Czech Republic; B. Braun Avitum Praha Nusle Dialysis Center, Táborská 325/57, 140 00, Prague 4, Czech Republic. Electronic address: havlin.jan@gmail.com.
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- $a BACKGROUND: Metabolic acidosis (MAC) is a common aspect of dialysis-dependent patients. It is definitely caused by acid retention; however, the influence of other plasma ions is unclear. Understanding the mechanism of MAC and its correction is important when choosing the dialysis solution. Therefore, we assessed the relationship between intradialytic change of acid-base status and serum electrolytes. METHODS: We studied 68 patients on post-dilution hemodiafiltration, using dialysate bicarbonate concentration 32mmol/L. The acid-base disorders were evaluated by the traditional Siggaard-Anderson and modern Stewart approaches. RESULTS: The mean pre-dialysis pH was 7.38, standard base excess (SBE) -1.5, undetermined anions (UA(-)) 7.5, sodium-chloride difference (Diff(NaCl)) 36.2mmol/L. MAC was present in 34% of patients, of which 83% had an increased UA(-) as a major cause of MAC. The mean nPCR was 0.99g/kg/day and correlated negatively with SBE. After dialysis, metabolic alkalosis predominated in 81%. The mean post-dialysis pH was 7.45, SBE 4, UA(-) 2.6, Diff(NaCl) 36.9mmol/L. ΔSBE significantly correlated with ΔUA(-), but not with ΔDiff(NaCl) or ΔCl(-). CONCLUSIONS: MAC in patients on hemodiafiltration is mainly caused by acid retention and is associated with higher protein intake. We did not prove the effect of sodium or chloride on acid-base balance. Even though we used a relatively low concentration of dialysate bicarbonate, we recorded a high proportion of post-dialysis alkalosis caused by the excessive decrease of undetermined anions, which had been completely replaced by bicarbonate and indicated the elimination of undesirable anions, as well as of normal endogenous anions.
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