Daily variability of acid-base status and determinants of serum bicarbonate in hemodialysis patients
Clinical Nephrology, cilt.98, sa.1, ss.26-32, 2022 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 98 Sayı: 1
- Basım Tarihi: 2022
- Doi Numarası: 10.5414/cn110735
- Dergi Adı: Clinical Nephrology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
- Sayfa Sayıları: ss.26-32
- Anahtar Kelimeler: acid-base disorders, he-modialysis, dialysis bath, drugs and dialysis vintage
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Aim: We aimed to evaluate daily variability of bicarbonate in hemodialysis (HD) patients and identify the factors which affect that issue. Materials and methods: Blood samples of 41 patients for bicarbonate (total carbon dioxide (CO2)) and blood gas analysis (pH, bicarbonate (HCO3-)) were obtained, pre-dialysis and post-dialysis, on the first, second, and third session of the week. Those with pre-dialysis HCO3- < 22 mmol/L in all sessions were classified as acidotic. Demographic and laboratory data of acidotic and non-acidotic groups were compared, and the factors related to HCO3- level were identified. Results: pH, tCO2, HCO3- of the first HD session were significantly lower than those of short inter-dialytic intervals (p < 0.001, respectively). Using Blant Altman analysis, pre- and post-dialysis tCO2 did not show good agreement with HCO3-. Acidotic patients had higher levels of serum albumin and phosphorus (p < 0.01 and p = 0.02, respectively) and were more likely to use sevelamer (p = 0.04). Also, the value of HCO3- was inversely correlated with dialysis vintage (r = -0.432, p = 0.005) and serum albumin (r = -0.427, p = 0.005). Conclusion: Since tCO2 did not show good agreement with HCO3-, relying solely on the pre-dialysis tCO2 values to define metabolic acidosis may increase misclassification rate. More work is needed for optimal assessment of acid-base status. Also, understanding the determinants of HCO3- may guide physicians for individualized HCO3- prescription.