Predictive factors of low HCO3– levels in peritoneal dialysis patients

Acid-Base Balance in Peritoneal Dialysis Patients: A Stewart-Fencl Analysis

“…Peritoneal transport characteristics no doubt affect transperitoneal base transport. [44,45] However, the relationship between peritoneal permeability and systemic acid base parameters is rather ambiguous, [6,7,9,45,46] and our study failed to document it. Regarding phosphate binders, which are used by the overwhelming majority of dialysis patients, some-but not all-studies in PD patients reported a correlation between calcium carbonate prescribing and serum bicarbonate, [47] and demonstrated the acidifying effect of sevelamer.…”

“…Regarding phosphate binders, which are used by the overwhelming majority of dialysis patients, some-but not all-studies in PD patients reported a correlation between calcium carbonate prescribing and serum bicarbonate, [47] and demonstrated the acidifying effect of sevelamer. [7,48] In our study, sevelamer was used by 23.5% of patients, calcium carbonate by 76.5%. Given the size of our sample, no detailed analysis of the effect of phosphate binder on ABB was undertaken.…”

“…Some have reported completely corrected acidosis in a larger proportion of patients; however, as bicarbonate was determined in venous plasma in these studies, its levels are likely to be slightly overestimated given the absence of local lactate production. [6][7][8]37] Abbreviations: SID = strong ion difference, [Na + −Cl − ] difference = sodium-chloride difference, [UA − ] = undetermined anions, AG = anion gap, AG − Alb − difference = difference between anion gap and charge carried by albumin, RRF = residual renal function.…”

“…Some studies suggest higher [HCO 3 − ] losses by residual nephrons, [8,[15,[40] while others do not support this hypothesis. [6,7] The possibility of dilution (due to inadequately high water intake) cannot be excluded either.…”

“…[1][2][3][4][5] Recent studies have shown that metabolic acidosis may persist in a non-negligible proportion of patients treated by PD (8-60%) while metabolic alkalosis may be present in other patients (17-27%). [6][7][8][9][10][11] Though in hemodialysis (HD) patients, both high and low serum bicarbonate levels are associated with an increased risk for mortality and hospitalization, [12] mild acidosis appears to be associated with a better outcome in PD patients. [13,14] The cause of metabolic acidosis in chronic renal failure has been thought to be an inability to excrete non-volatile acids in the face of reduced renal bicarbonate synthesis (i.e., acidosis with an increased anion gap, AG).…”