Acid–base balance in hemodialysis patients in everyday practice

Wieliczko, Monika; Małyszko, Jolanta

doi:10.1080/0886022x.2022.2094805

Cited by 7 publications

(7 citation statements)

References 42 publications

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“…33,34 This phenomenon may broadly overlap with acute, intradialytic drop of ionized calcium and clinical complaints of leg cramps during dialysis. [34][35][36] Preventive measures may include mitigating predialysis acidosis with exogenous bicarbonate supplementation, 37,38 but an effect on IDH has not been studied.…”

Section: Electrolyte Abnormalitiesmentioning

confidence: 99%

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Hamrahian,

Vilayet,

Herberth

et al. 2023

IJNRD

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Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and endorgan damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

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Section: Electrolyte Abnormalitiesmentioning

confidence: 99%

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Hamrahian,

Vilayet,

Herberth

et al. 2023

IJNRD

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“…Interestingly however, high predialytic blood bicarbonate concentration (blood [HCO 3 ]) in dialysis patients likely caused by excessive delivery of HCO 3 during HD resulting in postdialytic metabolic alkalosis associates with higher mortality 3 . It remains unclear how to optimize dialysate bicarbonate concentrations (D bic ) to both neutralize interdialytic acid generation yet minimize postdialytic alkalosis 4 – 6 .…”

Section: Introductionmentioning

confidence: 99%

Effect of time-dependent dialysate bicarbonate concentrations on acid–base and uremic solute kinetics during hemodialysis treatments

Wieliczko,

Twardowska-Kawalec,

Debowska

et al. 2024

Sci Rep

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Recent studies have suggested benefits for time-dependent dialysate bicarbonate concentrations (Dbic) during hemodialysis (HD). In this clinical trial, we compared for the first time in the same HD patients the effects of time-dependent changes with constant Dbic on acid–base and uremic solute kinetics. Blood acid–base and uremic solute concentration were measured in twenty chronic HD patients during 4-h treatments with A) constant Dbic of 35 mmol/L; B) Dbic of 35 mmol/L then 30 mmol/L; and C) Dbic of 30 mmol/L then 35 mmol/L (change of Dbic after two hours during Treatments B and C). Arterial blood samples were obtained predialysis, every hour during HD and one hour after HD, during second and third treatments of the week with each Dbic concentration profile. Blood bicarbonate concentration (blood [HCO3]) during Treatment C was lower only during the first three HD hours than in Treatment A. Overall blood [HCO3] was reduced during Treatment B in comparison to Treatment A at each time points. We conclude that a single change Dbic in the middle of HD can alter the rate of change in blood [HCO3] and pH during HD; time-dependent Dbic had no influence on uremic solute kinetics.

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“…2 It remains unclear how to optimise alkali delivery from dialysis solution to both neutralise interdialysis acid generation yet minimise postdialysis alkalosis. 10–12…”

Section: Introductionmentioning

confidence: 99%

“…2 It remains unclear how to optimise alkali delivery from dialysis solution to both neutralise interdialysis acid generation yet minimise postdialysis alkalosis. [10][11][12] Several theoretical studies have recently proposed new approaches for optimising the delivery of alkali from dialysis solution during chronic HD treatments. The most extensively model studied is that developed by Sargent et al, 13 the hydrogen ion (H + ) mobilization model, that describes intradialysis blood HCO 3 kinetics assuming HCO 3 is distributed in the extracellular fluid volume and is removed from that space by mobilisation of H + from buffers and other sources.…”

mentioning

confidence: 99%

Validity of the hydrogen ion mobilisation model during haemodialysis with time-dependent dialysate bicarbonate concentrations

et al. 2023

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Background: The hydrogen ion (H+) mobilisation model has been previously shown to accurately describe blood bicarbonate (HCO3) kinetics during haemodialysis (HD) when the dialysate bicarbonate concentration ([HCO3]) is constant throughout the treatment. This study evaluated the ability of the H+ mobilization model to describe blood HCO3 kinetics during HD treatments with a time-dependent dialysate [HCO3]. Methods: Data from a recent clinical study where blood [HCO3] was measured at the beginning of and every hour during 4-h treatments in 20 chronic, thrice-weekly HD patients with a constant (Treatment A), decreasing (Treatment B) and increasing (Treatment C) dialysate [HCO3] were evaluated. The H+ mobilization model was used to determine the model parameter (Hm) that provided the best fit of the model to the clinical data using nonlinear regression. A total of 114 HD treatments provided individual estimates of Hm. Results: Mean ± standard deviation estimates of Hm during Treatments A, B and C were 0.153 ± 0.069, 0.180 ± 0.109 and 0.205 ± 0.141 L/min (medians [interquartile ranges] were 0.145 [0.118,0.191], 0.159 [0.112,0.209], 0.169 [0.115,0.236] L/min), respectively; these estimates were not different from each other ( p = 0.26). The sum of squared differences between the measured blood [HCO3] and that predicted by the model were not different during Treatments A, B and C ( p = 0.50), suggesting a similar degree of model fit to the data. Conclusions: This study supports the validity of the H+ mobilization model to describe intradialysis blood HCO3 kinetics during HD with a constant Hm value when using a time-dependent dialysate [HCO3].

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Acid–base balance in hemodialysis patients in everyday practice

Cited by 7 publications

References 42 publications

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Effect of time-dependent dialysate bicarbonate concentrations on acid–base and uremic solute kinetics during hemodialysis treatments

Validity of the hydrogen ion mobilisation model during haemodialysis with time-dependent dialysate bicarbonate concentrations

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