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      Correction of Acidosis by Hemodialysis: Proposal of a Correlation with Urea Kinetics

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          Abstract

          Background/Aims: We examined the effect of hemodialysis (HD) on acid-base status and its relation to urea kinetics in clinically stable renal HD patients. The purpose of this study was to design a practical approach to monitoring the correction of acidosis, as it can be assisted by routine parameters of adequacy. Methods: Blood samples were drawn immediately before and after HD from 46 chronic renal patients to determine electrolytes, blood gases, serum albumin and blood urea nitrogen (BUN). Additional measurements of pH and serum bicarbonate were done in 35 patients in the periods before, immediately after and 4 h after HD. The normalized protein catabolic rate (nPCR) was calculated and correlated with the serum albumin and bicarbonate values before HD. Equilibrated KT/V (eKT/V) and urea reduction ratio (URR) were calculated and correlated with the degree of bicarbonate correction, defined as ΔHCO<sub>3</sub><sup>–</sup>. Results: There was no correlation between nPCR and pre-HD HCO<sub>3</sub><sup>–</sup>, while there was a significant correlation between URR and eKT/V and ΔHCO<sub>3</sub><sup>–</sup> (p < 0.003). Conclusions: The Δbicarbonate was well correlated with URR and eKT/V, and the study suggests that in standard HD the correction of acidosis may be related to target URR and eKT/V levels.

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          Moderate Metabolic Acidosis and Its Effects on Serum Parameters in Hemodialysis Patients

          We screened the laboratory data of 50 chronic hemodialysis patients selected randomly over a 21-month period to generate 158 data points which identified two groups: (1) those with a predialysis total CO 2 concentration less than or equal to 19 mEq/l (data A; n = 57) and (2) those with a predialysis total CO 2 concentration greater than 19 mEq/l (data B; n = 101). Then, both groups were compared for the following parameters: predialysis blood urea nitrogen (BUN), serum phosphorus, uric acid, creatinine, and albumin concentrations, Kt/V, urea reduction ratio, normalized protein catabolic rate, dry weight, ultrafiltration, blood flow and dialysis flow rates, duration of dialysis treatment, and blood pressure. Group data A had significantly higher predialysis BUN, phosphorus, and uric acid concentrations than group data B. There were significant inverse correlations between predialysis serum bicarbonate and predialysis BUN, phosphorus, and uric acid concentrations. Although it is not clear what the long term side effects of moderate metabolic acidosis are, we recommend its correction.
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            Author and article information

            Journal
            BPU
            Blood Purif
            10.1159/issn.0253-5068
            Blood Purification
            S. Karger AG
            0253-5068
            1421-9735
            2002
            2002
            15 January 2003
            : 20
            : 6
            : 551-556
            Affiliations
            Hospital Universitário Clementino Fraga Filho, Division of Nephrology, Federal University of Rio de Janeiro and Centro Integrado de Nefrologia, Rio de Janeiro, Brazil
            Article
            66959 Blood Purif 2002;20:551–556
            10.1159/000066959
            12566671
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 3, Tables: 1, References: 21, Pages: 6
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/66959
            Categories
            Original Paper

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