Determinants of metabolic acidosis among hemodialysis patients
- 1 April 2006
- journal article
- Published by Wiley in Hemodialysis International
- Vol. 10 (2), 209-214
- https://doi.org/10.1111/j.1542-4758.2006.00096.x
Abstract
Metabolic acidosis is frequently present, poorly controlled, and associated with adverse effects among hemodialysis patients. Potential determinants of metabolic acidosis include endogenous acid production, administration of alkali, neutralization of acid by buffers, dilution of serum bicarbonate by interdialytic fluid gain, and loss of bicarbonate in stool. Understanding the relative importance of these determinants may help guide efforts to manage metabolic acidosis. We used chart abstraction, patient interviews, and laboratory testing to assess variables related to acid production (protein breakdown), alkali administration (dialysis dose, missed treatments, dialysate bicarbonate concentration, oral bicarbonate supplements), acid buffering (phosphorus binders), dilution of bicarbonate (interdialytic weight gain), and loss of bicarbonate in stool (diarrhea) for 190 randomly selected patients from 44 hemodialysis facilities. We used multivariate analyses to determine which potential determinants were independently associated with predialysis serum bicarbonate levels. Of all patients, 30% had metabolic acidosis (serum bicarbonate level <22 mEq/L). On multivariate analysis, metabolic acidosis was more likely with increased protein nitrogen appearance (odds ratio [OR] 1.60 per 0.2 g/kg/day, p=0.001) and less likely with increased Kt/V (OR 0.61 per 0.20 increase in Kt/V, p<0.001) and with increased calcium carbonate use (OR 0.38 per 2 g/day, p=0.003). Key determinants of metabolic acidosis among hemodialysis patients are protein breakdown, dialysis dose, and specific phosphorus binders. Further work is needed to develop interventions to address these determinants.Keywords
This publication has 19 references indexed in Scilit:
- Risks of chronic metabolic acidosis in patients with chronic kidney diseaseKidney International, 2005
- Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS)American Journal of Kidney Diseases, 2004
- A comparison of clinically useful phosphorus binders for patients with chronic kidney failureKidney International, 2004
- Metabolic acidosis in maintenance dialysis patients: Clinical considerationsKidney International, 2003
- ACID‐BASE IN RENAL FAILURE: Influence of Diet on Acid‐Base BalanceSeminars in Dialysis, 2000
- ACID‐BASE IN RENAL FAILURE: Acidosis and Nutritional Status in Hemodialyzed PatientsSeminars in Dialysis, 2000
- Association of acidosis and nutritional parameters in hemodialysis patientsAmerican Journal of Kidney Diseases, 1999
- Correction of metabolic acidosis and its effect on albumin in chronic hemodialysis patientsAmerican Journal of Kidney Diseases, 1998
- Chronic metabolic acidosis decreases albumin synthesis and induces negative nitrogen balance in humans.JCI Insight, 1995
- Death Risk in Hemodialysis Patients: The Predictive Value of Commonly Measured Variables and an Evaluation of Death Rate Differences Between FacilitiesAmerican Journal of Kidney Diseases, 1990