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Bicarbonate dialysis

Márcio Viegas, Cristina Cândido, Joana Felgueiras, José Clemente, Sara Barros, Rostislav Farbota, Filipa Vera, Antero Matos, Francisco Sousa
Introduction The dialysate bicarbonate (DB) influences the acid-base balance in dialysis patients. Very low and high serum bicarbonate (SB) have been related with a higher mortality. Acid-base balance also has been associated with hemodynamic effects in these patients. The trial aim was to compare the effect of DB concentration variation on SB levels in maintenance hemodiafiltration (HDF) patients and the effect on intradialytic hypotension and interdialytic weight gain. Methods  A prospective study, with 9 months of follow-up, involving 93 patients, divided in two groups: group 1 and group 2 with a DB of 34 mmol/L and 30 mmol/L, respectively, with monitoring of pre and post HDF SB, intradialytic hypotension, and interdialytic weight gain...
October 20, 2016: Hemodialysis International
Navdeep Tangri, Lesley A Inker, Brett Hiebert, Jenna Wong, David Naimark, David Kent, Andrew S Levey
BACKGROUND: Predicting the progression of chronic kidney disease (CKD) is vital for clinical decision making and patient-provider communication. We previously developed an accurate static prediction model that used single-timepoint measurements of demographic and laboratory variables. STUDY DESIGN: Development of a dynamic predictive model using demographic, clinical, and time-dependent laboratory data from a cohort of patients with CKD stages 3 to 5. SETTING & PARTICIPANTS: We studied 3,004 patients seen April 1, 2001, to December 31, 2009, in the outpatient CKD clinic of Sunnybrook Hospital in Toronto, Canada...
September 29, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Foroogh Sabzghabaei, Seyed Alireza Heydariezade, Rashin S Joodat
INTRODUCTION: Hemodialysis (HD) has impact on the cardiovascular system by inducing changes in the characteristics of body fluids such as PH, temperature and electrolyte concentrations. In the previous studies, prolongation of the QT interval and increase of QT dispersion have been reported during HD sessions. These changes were more significant while using solutions with less potassium and higher bicarbonate during dialysis. OBJECTIVES: The aim of our study was to investigate the effects of different potassium and bicarbonate concentrations on electrocardiography (ECG) parameters and the electrochemical balance of cell membranes...
2016: Journal of Renal Injury Prevention
Marco Marano, Anna D'Amato, Alessandra Cantone
The large prevalence of respiratory acid-base disorders overlapping metabolic acidosis in hemodialysis population should prompt nephrologists to deal with the partial pressure of carbon dioxide (pCO2) complying with the reduced bicarbonate concentration. What the most suitable formula to compute pCO2 is reviewed. Then, the neglected issue of CO2 content in the dialysis fluid is under the spotlight. In fact, a considerable amount of CO2 comes to patients' bloodstream every hemodialysis treatment and "acidosis by dialysate" may occur if lungs do not properly clear away this burden of CO2...
September 6, 2016: World Journal of Nephrology
Ana Rodríguez-Carmona, Miguel Pérez Fontán, Susana Sangiao Alvarellos, Teresa García Falcón, María Lara Pena Bello, Andrés López Muñiz, Fernando Cordido
BACKGROUND: Irisin is an adipomyokine with claimed anti-obesity and anti-diabetic effects. This hormone has been insufficiently studied in patients with advanced chronic kidney disease (CKD). OBJECTIVE: To perform an exploratory analysis of serum irisin levels in patients undergoing different CKD treatments. METHOD: Following a cross-sectional design, we estimated serum levels of irisin in 95 patients with CKD managed conservatively (advanced CKD), with peritoneal dialysis (PD) or with haemodialysis, and compared our findings with a control group of 40 healthy individuals...
September 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Vincenzo Bellizzi, Giuseppe Conte, Silvio Borrelli, Adamasco Cupisti, Luca De Nicola, Biagio R Di Iorio, Gianfranca Cabiddu, Marcora Mandreoli, Ernesto Paoletti, Giorgina B Piccoli, Giuseppe Quintaliani, Maura Ravera, Domenico Santoro, Serena Torraca, Roberto Minutolo
This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs...
August 27, 2016: Journal of Nephrology
Adamasco Cupisti, Claudia D'Alessandro, Gian Marco Caselli
Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Jianjun Gao, Zhaoyan Gu, Yongxing Xu, Yu Na
We report a case of metformin-associated lactic acidosis (MALA) in a 66-year-old man with end-stage renal disease on peritoneal dialysis (PD). The patient presented with severe lactic acidosis and was treated successfully with automated peritoneal dialysis (APD). During the treatment, PD solution was prepared from hemofiltration substitute fluid. The prescription was 8 cycles of 2,000 mL over 24 hours with the prepared solution, and venoclysis with sodium bicarbonate to improve the acidosis. After 3 days of treatment, his lactic acidosis was corrected...
November 2016: Clinical Nephrology
Mayoor V Prabhu, Arun S, Venkat Ramesh
INTRODUCTION: In the tropics, the triad of fever, thrombocytopenia, and AKI portends a grim prognosis with high mortality and a severe strain on already-stretched resources. Malaria, dengue, and leptospirosis account for most cases. We undertook a review of cases to determine factors accounting for adverse prognosis. METHODS: All patients presenting to the emergency room (ER) with a history of fever, thrombocytopenia, and renal failure were included in the study...
August 10, 2016: Clinical Nephrology
Susan Wan, Matthew A Roberts, Peter Mount
BACKGROUND: The ideal intravenous fluid for kidney transplantation has not been defined, despite the common use of normal saline during the peri-operative period. The high chloride content of normal saline is associated with an increased risk of hyperchloraemic metabolic acidosis, which may in turn increase the risk of hyperkalaemia and delayed graft function. Balanced electrolyte solutions have a lower chloride content which may decrease this risk and avoid the need for dialysis due to hyperkalaemia in the immediate post-transplant period...
2016: Cochrane Database of Systematic Reviews
Patricia Dreyer, Monique Nakayama Ohe, Livia Marcela Dos Santos, Ilda Sizue Kunii, Rodrigo Oliveira Santos, Aluizio Barbosa de Carvalho, Jose Gilberto Henriques Vieira
INTRODUCTION: Hyperparathyroidism is a frequent complication of chronic kidney disease (CKD). Total parathyroidectomy (PTX) with parathyroid tissue autotransplantation (AT) is a treatment option in those individuals that do not respond to clinical management. OBJECTIVE: To evaluate grafted parathyroid tissue response during induced hypocalcemia among CKD patients who underwent total PTX with AT. METHODS: Eighteen patients with renal hyperparathyroidism were submitted to total PTX with parathyroid AT selected by stereomicroscopy between April and October 2008...
June 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Kamyar Kalantar-Zadeh
Several observational studies have reported an association between higher serum bicarbonate level and high mortality risk in dialysis patients. However, in such studies mere discovery of associations does not allow one to infer causal relationships. This association may be related to inadequate dietary protein intake that may lead to less acid generation and hence a higher serum bicarbonate level. Since undernutrition is a strong predictor of death in hemodialysis patients, the observed association may be an epiphenomenon and not a biologically plausible relationship...
August 2016: Nephrology, Dialysis, Transplantation
Philippe Chauveau, Claire Rigothier, Christian Combe
Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival...
August 2016: Nephrology, Dialysis, Transplantation
Madhukar Misra
Chronic metabolic acidosis is common in dialysis patients. Bicarbonate administration via the dialysate helps maintain the acid-base balance in these patients. Serum bicarbonate level in dialysis patients is determined by several factors that include dietary protein intake, nutritional status and dialysis prescription, etc. Additionally, a meaningful interpretation of serum bicarbonate in dialysis patients requires an understanding of complexities involving its measurement. Both very low as well very high levels of serum bicarbonate have been associated with adverse outcomes in observational studies...
August 2016: Nephrology, Dialysis, Transplantation
Fernando Caravaca-Fontán, Boris Gonzales-Candia, Enrique Luna, Francisco Caravaca
INTRODUCTION: The cause of vitamin D deficiency in chronic kidney disease (CKD) is probably multi-factorial; however, the relative importance of each potential determinant is uncertain. AIMS: To determine factors associated with serum levels of 25-hydroxy vitamin D (25OHD) and their relative importance in a cohort of pre-dialysis CKD patients. MATERIAL AND METHODS: Incident patients admitted to a CKD outpatient clinic were included. Those who were receiving vitamin D supplements or anticonvulsants were excluded...
July 1, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Silvio Borrelli, Roberto Minutolo, Luca De Nicola, Walter De Simone, Emanuele De Simone, Bruno Zito, Biagio Raffaele Di Iorio, Lucia Di Micco, Luigi Leone, Antonio Bassi, Angelo Romano, Maria Carla Porcu, Riziero Fini, Edward Vezza, Caterina Saviano, Ludovica D'Apice, Roberto Simonelli, Vincenzo Bellizzi, Giuseppe Palladino, Olga Credendino, Raffaele Genualdo, Maria Capuano, Pasquale Guastaferro, Filippo Nigro, Vittorio Stranges, Giuseppe Iuianiello, Francesco Saverio Russo, Maria Rita Auricchio, Antonio Treglia, Patrizia Palombo, Nunzio Rifici, Remo Nacca, Alberto Caliendo, Stefania Brancaccio, Giuseppe Conte
INTRODUCTION: in hemodialysis (HD) patients, poor health-related quality of life (HR-QoL) is prevalent and associated with adverse outcomes. HR-QoL is strictly linked to nutritional status of HD patients. Hemodiafiltration with endogenous reinfusion (HFR) is an alternative dialysis technique that combines diffusion, convection and absorption. It reduces burden of inflammation and malnutrition and this effect may cause beneficial effect on HR-QoL. However no data on HR-QoL in HFR is currently available...
May 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Masamitsu Morishita, Nanae Matsuo, Yukio Maruyama, Masatsugu Nakao, Izumi Yamamoto, Yudo Tanno, Ichiro Ohkido, Masato Ikeda, Keitaro Yokoyama, Takashi Yokoo
BACKGROUND: Several guidelines have set the target levels of serum Ca, phosphorus, and parathyroid hormone (PTH) for better management of chronic kidney disease-mineral and bone disorders (CKDMBD) in dialysis patients. Although serum ionized Ca (iCa) is a biologically active component, corrected Ca (cCa) is used in clinical settings. However, the association between iCa and cCa is affected by acid-base status. We investigated the difference in acid-base and the calcium-parathyroid status between hemodialysis (HD) and peritoneal dialysis (PD)...
August 2016: Clinical Nephrology
Joana Sampaio, Diana Machado, Ana Marta Gomes, Idalina Machado, Cledir Santos, Nelson Lima, Maria João Carvalho, António Cabrita, Anabela Rodrigues, Margarida Martins
Infections are major complications in peritoneal dialysis (PD) with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16) and non-infectious causes (n = 31)...
2016: PloS One
Jeffrey A Kraut, Nicolaos E Madias
Mortality rates associated with severe lactic acidosis (blood pH<7.2) due to sepsis or low-flow states are high. Eliminating the triggering conditions remains the most effective therapy. Although recommended by some, administration of sodium bicarbonate does not improve cardiovascular function or reduce mortality. This failure has been attributed to both reduction in serum calcium concentration and generation of excess carbon dioxide with intracellular acidification. In animal studies, hyperventilation and infusion of calcium during sodium bicarbonate administration improves cardiovascular function, suggesting that this approach could allow expression of the positive aspects of sodium bicarbonate...
September 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Guillermo Rosa-Diez, Armando Luis Negri, Maria Soledad Crucelegui, Romina Philippi, Hernán Perez-Teysseyre, Carmen Sarabia-Reyes, Henry Loor-Navarrete, Ricardo Heguilen
BACKGROUND: Sevelamer has been associated with less progression of vascular calcifications. This effect could be due to a reduction in serum phosphate levels but also to other additive effects. Magnesium has been also shown to prevent vascular calcification but the effect of sevelamer on serum magnesium levels has not been thoroughly evaluated. Our aim was to analyze whether the use of sevelamer reduces the risk of hypomagnesemia in hemodialysis (HD)-requiring end-stage renal disease patients...
June 2016: Clinical Kidney Journal
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