Bicarbonate Therapy in End‐Stage Renal Disease: Current Practice Trends and Implications

Abstract

Management of metabolic acidosis covers the entire spectrum from oral bicarbonate therapy and dietary modifications in chronic kidney disease to delivery of high doses of bicarbonate-based dialysate during maintenance haemodialysis (MHD). Due to the gradual depletion of the body's buffers and rapid repletion during MHD, many potential problems arise as a result of our current treatment paradigms. Several studies have given rise to conflicting data about the adverse effects of our current practice patterns in MHD. In this review, we will describe the pathophysiology and consequences of metabolic acidosis and its therapy in CKD and ESRD, and discuss current evidence supporting a more individualized approach for bicarbonate therapy in MHD.

Aiming for the optimal bicarbonate prescription for maintenance hemodialysis therapy in end‐stage renal disease

“…Not only correction but also maintenance of acid‐base balance, throughout the interdialytic period, remains an important aspect of renal replacement therapy, since correcting acidosis limits the severity of mineral bone disease, bone metabolism, and formation …”

“…1,2 Not only correction but also maintenance of acid-base balance, throughout the interdialytic period, remains an important aspect of renal replacement therapy, since correcting acidosis limits the severity of mineral bone disease, bone metabolism, and formation. [3][4][5][6] Current K/DOQI guidelines recommend pre-dialysis or stabilized serum bicarbonate (HC03 − ) levels should be maintained at/or above 22 mmol/L. 7 During each hemodialysis (HD) session, patients (pts) are exposed to the HC03 − bath in the dialysate fluid and can effectively correct metabolic acidosis.…”

Conservation of Mass: An Important Tool in Renal Research

“…In addition, other research protocols should be designed so that results can be interpreted relative to these commonly understood baselines. Employing conservation of mass, transport, and mathematical representations in the investigation of the obligatory physiological perturbations that result from dialysis therapy. For example, while the challenge of acid–base correction in the ESRD patient cannot be completely specified, the highly disruptive nature of this process lends itself to quantitative analysis using mass conservation principles and quantification of solute transport.…”

Study of association of serum bicarbonate levels with mortality in chronic kidney disease

“…of Deaths 21% chronic kidney disease is possible and easy to use making it a good option. 4,5,16 Hence it is essential to optimize serum bicarbonates with oral supplementation. [6][7][8][9] According to present study it was noted that the incidence of Chronic Kidney Disease varied from minimum age of 20 years to maximum age of 88 years (Table 1).…”

“…Acid-base balance is maintained by elimination of carbon dioxide by the lungs and excretion of nonvolatile acid by the kidneys which affects the plasma bicarbonate concentration. 4 The hydrogen ion concentration of the blood is determined by the ratio of the pCO 2 and plasma bicarbonate concentration. Metabolic acidosis can be due to one or more of the following pathophysiologic processes such as increased production of nonvolatile acids, increased loss of bicarbonate and decreased renal excretion of acid.…”