Spurious metabolic acidosis in hemodialysis patients

Kirschbaum, Barry B.

doi:10.1016/s0272-6386(00)70041-2

Cited by 66 publications

(39 citation statements)

References 5 publications

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“…Hence, measurement variability is minimized. However, we agree that there are serious problems with the accuracy of the measurement of serum bicarbonate in largescale studies (64). Moreover, epidemiologic analyses can identify only associations; causal relationships need to be demonstrated by clinical trials.…”

Section: Discussionmentioning

confidence: 56%

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Shinaberger

Regidor

et al. 2006

Clinical Journal of the American Society of Nephrology

146

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Section: Discussionmentioning

confidence: 56%

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Shinaberger

Regidor

et al. 2006

Clinical Journal of the American Society of Nephrology

146

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“…One of the reasons for the higher prevalence of low serum bicarbonate levels in our study may be that the measurements were made in samples shipped overnight to a central laboratory; this practice has been shown to result in lower serum bicarbonate levels (27). Nevertheless, almost 80% of dialysis patients in the United States are treated in facilities owned by large dialysis organizations (28); all laboratory specimens in these facilities are shipped overnight to a central laboratory.…”

Section: Discussionmentioning

confidence: 97%

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Vashistha

Kalantar-Zadeh

Molnar

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Uremic metabolic acidosis is only partially corrected in many hemodialysis patients, and low serum bicarbonate predicts higher death risk. This study determined the comparative efficacy of peritoneal dialysis in correcting uremic metabolic acidosis and the association of serum bicarbonate and death risk with the two therapies. Design, setting, participants, & measurements Data were obtained from 121,351 prevalent ESRD patients (peritoneal dialysis, 10,400; hemodialysis, 110,951) treated in DaVita facilities between July 1, 2001 and June 30, 2006, with follow-up through June of 2007. Results Serum bicarbonate was <22 mEq/L in 25% and 40% of peritoneal dialysis and hemodialysis patients, respectively. Thus, peritoneal dialysis patients were substantially less likely to have lower serum bicarbonate (adjusted odds ratio<20 mEq/L, 0.45 [0.42, 0.49]; <22 mEq/L, 0.41 [0.39, 0.43]). Time-averaged serum bicarbonate<19 mEq/L was associated with an 18% and 25% higher risk for all-cause and cardiovascular mortality, respectively, in prevalent peritoneal dialysis patients (reference group: serum bicarbonate between 24 and <25 mEq/L). In analyses using the entire cohort of peritoneal dialysis and hemodialysis patients, the adjusted risk for all-cause mortality was higher in most subgroups with serum bicarbonate<22 mEq/L, irrespective of dialysis modality. Conclusions The measured bicarbonate is significantly higher in peritoneal dialysis patients, suggesting that the therapy provides a more complete correction of metabolic acidosis than intermittent hemodialysis. Survival data suggest maintaining serum bicarbonate>22 mEq/L for all ESRD patients, irrespective of dialysis modality.

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“…Another is that bicarbonate was measured at the point of care, which is important, because measurement delays can result in falsely low values (45). Also, mortality event rates were high in this cohort.…”

Section: Discussionmentioning

confidence: 98%

Bicarbonate Concentration, Acid-Base Status, and Mortality in the Health, Aging, and Body Composition Study

Raphael¹,

Murphy²,

Shlipak³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Low serum bicarbonate associates with mortality in CKD. This study investigated the associations of bicarbonate and acid-base status with mortality in healthy older individuals.Design, setting, participants, & measurements We analyzed data from the Health, Aging, and Body Composition Study, a prospective study of well functioning black and white adults ages 70-79 years old from 1997. Participants with arterialized venous blood gas measurements (n=2287) were grouped into ,23.0 mEq/L (low), 23.0-27.9 mEq/L (reference group), and $28.0 mEq/L (high) bicarbonate categories and according to acid-base status. Survival data were collected through February of 2014. Mortality hazard ratios (HRs; 95% confidence intervals [95% CIs]) in the low and high bicarbonate groups compared with the reference group were determined using Cox models adjusted for demographics, eGFR, albuminuria, chronic obstructive pulmonary disease, smoking, and systemic pH. Similarly adjusted Cox models were performed according to acid-base status.Results The mean age was 76 years, 51% were women, and 38% were black. Mean pH was 7.41, mean bicarbonate was 25.1 mEq/L, 11% had low bicarbonate, and 10% had high bicarbonate. Mean eGFR was 82.1 ml/min per 1.73 m 2 , and 12% had CKD. Over a mean follow-up of 10.3 years, 1326 (58%) participants died. Compared with the reference group, the mortality HRs were 1.24 (95% CI, 1.02 to 1.49) in the low bicarbonate and 1.03 (95% CI, 0.84 to 1.26) in the high bicarbonate categories. Compared with the normal acid-base group, the mortality HRs were 1.17 (95% CI, 0.94 to 1.47) for metabolic acidosis, 1.21 (95% CI, 1.01 to 1.46) for respiratory alkalosis, and 1.35 (95% CI, 1.08 to 1.69) for metabolic alkalosis categories. Respiratory acidosis did not associate with mortality.Conclusions In generally healthy older individuals, low serum bicarbonate associated with higher mortality independent of systemic pH and potential confounders. This association seemed to be present regardless of whether the cause of low bicarbonate was metabolic acidosis or respiratory alkalosis. Metabolic alkalosis also associated with higher mortality.

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Spurious metabolic acidosis in hemodialysis patients

Cited by 66 publications

References 5 publications

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Association between Serum Bicarbonate and Death in Hemodialysis Patients

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Bicarbonate Concentration, Acid-Base Status, and Mortality in the Health, Aging, and Body Composition Study

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