ACID‐BASE IN RENAL FAILURE: New Perspectives on Acid‐Base Balance (original) (raw)

Opinion: What Unique Acid-Base Considerations Exist in Dialysis Patients?

Seminars in Dialysis, 2004

Because a typical modern diet results in net production of acid, and the kidney is normally the main organ responsible for generating alkali to maintain acid-base homeostasis, chronic metabolic acidosis is commonly observed in patients with chronic renal insufficiency. In this article we will deal with the clinical characteristics, pathophysiology, and therapeutic approach to this condition.

ACID-BASE IN RENAL FAILURE: Acidosis and Nutritional Status in Hemodialyzed Patients

Seminars in Dialysis, 2001

In a cross-sectional study of more than 30% of French dialysis patients (N = 7,123), we evaluated the relationships between predialysis plasma bicarbonate concentration and nutritional markers. Data including age, gender, cause of end-stage renal disease (ESRD), time on dialysis, body mass index (BMI), blood levels of midweek predialysis albumin, prealbumin, and bicarbonate were collected. Normalized protein catabolic rate (nPCR), dialysis adequacy parameters, and estimation of lean body mass (LBM) were computed from pre-and postbicarbonate-dialysis urea and creatinine levels according to the classical formulas of Garred. Average values (±1 SD) were age 61 ± 16 years, BMI 23.3 ± 4.6 kg/m 2 , dialysis time 12.4 ± 2.7 h/week, HCO 3 22.8 ± 3.5 mmol/L, albumin 38.7 ± 5.3 g/L, prealbumin 340 ± 90 mg/L, Kt/V 1.36 ± 0.36, nPCR 1.13 ± 0.32 g/kg BW/day, and LBM 0.86 ± 0.21% of ideal LBM. A highly significant negative correlation was observed between predialysis bicarbonate levels (within a range of 16-30 mmol/L, 95% of this population) and nPCR confirmed by analysis of variance using bicarbonate classes (p < 0.0001). Bicarbonate was also negatively correlated with albumin, prealbumin, BMI, and LBM. No relationship was noted between bicarbonate and Kt/V despite a positive correlation between Kt/V and nPCR. It is likely that a persistent acidosis observed despite standard bicarbonate dialysis was caused by a high dietary protein intake which results in an increased acid load, but also overcomes the usual catabolic effects of acidosis.

Managing Metabolic Acidosis in Chronic Renal Diseases

Journal of Advanced Health Informatics Research, 2023

One of the most common side effects of chronic kidney disease is metabolic acidosis (CKD). It is associated with the development of CKD and various other functional disorders. Metabolic acidosis can be a common complication associated with progressive loss of kidney function. The form can be a metabolic acidosis with a non-anion gap or metabolic acidosis with a high or mixed anion gap. Reduced kidney ability to maintain acid-base homeostasis results in acid accumulation, causing various complications such as decreased nutritional status such as wasting muscle-hypoalbuminemia, inflammation, uremic bone disease and its association with increased mortality. In addition to the side effects associated with acid retention, metabolic acidosis can also cause kidney damage, possibly through stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis in the event of decreased renal function. chronic kidney disease (CKD), and therefore offers an effective, safe and affordable reno-protective strategy. This paper will discuss the physiology and pathophysiology of acid-base homeostasis in CKD, namely the mechanism of metabolic acidosis capable of impairing kidney function, and its relation to the benefits of alkaline therapy. based on clinical trials.

Metabolic acidosis and its association with nutritional status in hemodialysis

Jornal Brasileiro de Nefrologia, 2015

Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients. Objectives: To assess the prevalence of metabolic acidosis in hemodialysis and search their association with nutritional status. Methods: A cross-sectional study was performed in hemodialysis patients at a single center. Nutritional status was assessed by anthropometric, biochemical and multifrequency bioelectrical impedance analysis. Metabolic acidosis was defined as serum bicarbonate (BIC) < 22 mEq/L and patients were divided into 3 groups according to BIC (< 15.15 to 21.9 and ≥ 22). The association between BIC and continuous variables was investigated using the Kruskal Wallis test. The linear correlation between BIC and the variables of the study was also tested. Results: We studied 95 patients, 59% male, mean age 52.3 years. The prevalence of metabolic acidosis was 94.7%. BMI, interdialytic weight gain and PTH were significantly different among the 3 groups of BIC. The BIC was negatively correlated with urea, phosphorus and interdialytic weight gain. There was no significant correlation with albumin, phase angle and lean body mass index. Conclusion: The prevalence of metabolic acidosis was high in this population, and a lower BIC correlated with higher levels of urea, PTH, phosphorus, interdialytic weight gain and lower BMI. The evaluation of acid-basic status should be routinely implemented in dialysis patients by considering the negative effects of acidosis on the nutritional status, inflammation and bone disease.