Bicarbonate Balance and Prescription in ESRD

Abramowitz, Matthew K.

doi:10.1681/asn.2016070780

Cited by 44 publications

(40 citation statements)

References 100 publications

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“…Mechanistically, high-bicarbonate dialysate/prescription has been shown to have effects on the QT interval [12,13], hemodynamics [14][15][16], levels of serum potassium [17], and ionized calcium [18], which may increase the risk for ventricular arrhythmia [19][20][21]. Studies have linked changes in ionized calcium to high bicarbonate dialysate prescription [18,22], but we only had data on total calcium, and hence could not study the effects on ionized calcium, while other studies have found results similar to ours [23,24].…”

Section: Discussionmentioning

confidence: 99%

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

et al. 2019

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Background: The etiology of sudden cardiac death in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is largely unknown, though there is evidence to suggest that metabolic alkalosis induced by HD with a high-bicarbonate dialysate/prescription may play a role. Methods: We investigated the effects of metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate on frequency of ventricular arrhythmia in 47 patients with ESRD on chronic HD using 48-h Holter monitoring in 3 phases: intra-HD, post-HD day 1, and post-HD day 2. Serum levels of bicarbonate, calcium, and potassium along with hemodynamics were measured pre-HD, post-HD, 20-h post-HD, and 44-h post-HD. Correlations were performed to verify the association between bicarbonate prescription and change in serum bicarbonate levels post-HD and to determine if the HD-induced change in serum bicarbonate level (metabolic alkalosis) had any direct association with ambient ventricular arrhythmia (premature ventricular contractions per hour) or indirect associations with ambient ventricular arrhythmia by affecting electrolytes or hemodynamics that are known to increase the risk of ventricular arrhythmia. Results: Mean pre-HD serum bicarbonate level was 21.3 mEq/L. Dialysate bicarbonate prescription (mean of 36.4 mEq/L) correlated with changes in serum bicarbonate levels immediately post-HD 26.7 mEq/L (r = 0.46, p < 0.01), 20-h post-HD 25.2 mEq/L (r = 0.38), and 44-h post-HD 23.2 mEq/L (r = 0.35, p = 0.01). No statistically significant correlations were found between the post-HD change in serum bicarbonate levels (metabolic alkalosis) with ambient ventricular arrhythmia, changes in serum calcium, potassium, or hemodynamics in any phase. Conclusions: High-bicarbonate dialysate prescription is associated with metabolic alkalosis following the HD procedure. A mild metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate solution had no direct association with ambient ventricular arrhythmia on Holter monitoring and was not associated with changes in hemodynamics or changes in serum total calcium or potassium levels. This study helps to provide guidance for the safe use of high bicarbonate dialysate/prescription in patients with ESRD on HD.

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Section: Discussionmentioning

confidence: 99%

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

et al. 2019

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“…There is ongoing controversy regarding the optimal composition of dialysate, especially with regard to sodium, potassium, and bicarbonate . Differences in dialysate composition may influence both clinical and patient related outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…There is ongoing controversy regarding the optimal composition of dialysate, especially with regard to sodium, 6-9 potassium, [10][11][12] and bicarbonate. [13][14][15] Differences in dialysate composition may influence both clinical and patient related outcomes. Higher dialysate sodium concentrations have been associated with higher postdialysis blood pressure measurements and larger interdialytic weight gains (IDWG).…”

Section: Introductionmentioning

confidence: 99%

Low dialysate potassium concentration is associated with prolonged recovery time

Harford

Gul

Cumber

et al. 2017

Hemodialysis International

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Introduction: Modifiable hemodialysis treatment parameters may impact patient reported outcomes, including recovery time. Answers to the recovery question may predict the impact of treatment parameters on clinical outcomes and health related quality of life. However, the reliability of answers to the recovery question after consecutive and nonconsecutive dialysis treatments in diverse populations has not been established.Objective: To assess the reliability of this instrument and to determine if recovery time was associated with modifiable dialysis parameters, we conducted a quality assurance project in which we asked, "How long did it take you to recover from your last dialysis session?" after consecutive and nonconsecutive treatments. Methods:We asked patients the recovery question seven times. We computed polychoric correlations to assess within patient correlations. We used random intercept ordinal logistic regression models to test for associations of recovery time with patient variables. Results:We obtained answers to the recovery question in association with 1572 treatments in 364 patients. Recovery time was <2 hours in 52.1%; 2 to 7 hours in 20.9%; and >7 hours in 27.0% of treatments. Polychoric correlations demonstrated highly reliable responses within individual patients between consecutive and nonconsecutive treatments. Prolonged recovery was associated with a dialysate potassium of 1 vs. 2 mEq/L (odds ratio [OR] Conclusions: Responses to the recovery question were reliable and low dialysate potassium was associated with prolonged recovery.

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“…One possibility is the differential effect of OL-HDF versus HD on PaCO 2 levels. It is understood that patients' PaCO 2 will rise during dialysis treatment due to the production of CO 2 from dialysate bicarbonate [29,30], and that rapid elevation of PaCO 2 can trigger chemoreceptors and cause respiratory disturbance [29]. Dysfunctional chemoreceptor responsiveness is believed to be the major cause of CSA in patients with kidney disease [31] and patients with ESKD are known to have increased chemoreceptor sensitivity [32].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

et al. 2020

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Background: Sleep apnoea is prevalent in dialysis patients. Previous studies identified excessive inflammation in patients with sleep apnoea. Online haemodiafiltration (OL-HDF) may reduce systematic inflammation through better clearance of middle molecules. We aimed to determine the feasibility of OL-HDF in sleep apnoea management. Methods: Eligible dialysis patients were screened for risk of sleep apnoea by nocturnal oximetry followed by a diagnostic sleep study to assess apnoea-hypopnea index (AHI). Patients with AHI ≥15/h were invited to a randomized crossover trial. The intervention was 2-month high-flux haemodialysis (HF-HD) followed by 2-month OL-HDF or vice versa with 1-month washout via HF-HD. Feasibility was assessed by patient recruitment and the primary outcome, severity of sleep apnoea (AHI). Secondary outcomes were pro-inflam-matory cytokines, patient-reported daytime sleepiness, quality of sleep and health-related quality of life. Results: Of 65 participants at risk of sleep apnoea, only 15 were consented and randomized (mean age 70 years, 80% male, mean AHI 42.2/h). AHI was not statistically different between OL-HDF versus HF-HD (55.6/h vs. 48.3/h, p = 0.134); however, when sleep apnoea was stratified into obstructive and central apnoea, patients had less obstructive episodes after treated by OL-HDF (23.2/h vs. 18.6/h, p = 0.178); a sensitivity analysis was performed excluding outliers, and the treatment effect for obstructive episodes was found to be statistically significant (11.1 vs. 18.2/h, p = 0.019). Pro-inflammatory biomarkers and patient-reported outcomes were similar between OL-HDF and HF-HD. Conclusion: Patient recruitment was a major challenge in this feasibility study. OL-HDF may reduce obstructive sleep apnoea; however, the result needs to be confirmed by larger studies.

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Bicarbonate Balance and Prescription in ESRD

Cited by 44 publications

References 100 publications

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

Low dialysate potassium concentration is associated with prolonged recovery time

Feasibility of Online Haemodiafiltration in Sleep Apnoea: A Randomized Crossover Study

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