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

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          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.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            15 January 2003
            : 20
            : 6
            : 551-556
            Hospital Universitário Clementino Fraga Filho, Division of Nephrology, Federal University of Rio de Janeiro and Centro Integrado de Nefrologia, Rio de Janeiro, Brazil
            66959 Blood Purif 2002;20:551–556
            © 2002 S. Karger AG, Basel

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