Noh U-Seok, Yi Joo-Hark, Han Sang-Woong, Kim Ho-Jung
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Electrolyte Blood Press. 2007 Dec;5(2):95-101. doi: 10.5049/EBP.2007.5.2.95. Epub 2007 Dec 31.
This study aimed to assess the effects of different dialysate bicarbonate concentrations in correcting acid-base imbalance in 53 stable hemodialysis patients in a university-hemodialysis unit. Three different bicarbonate concentrations were assigned, i.e. 25 mEq/L in 10, 30 mEq/L in 30, and 35 mEq/L in 13 patients. Blood gas analyses from arterial line blood samples before and after dialysis in the mid-week were performed for the determination of pH and serum bicarbonate (HCO3 (-)) concentration. The mean values of predialysis arterial HCO3 (-) were mildly acidotic in all 3 groups, but not significantly different among them, whereas those of post-dialysis arterial HCO3 (-) were alkalotic, especially in the group of 35 mEq/L as compared with the other two groups. The mean blood pH was not significantly different among the 3 groups. As expected, there was a positive correlation between pre-dialysis pH and post-dialysis pH (r=0.45, p=0.001), and pre-dialysis HCO3 (-) and post-dialysis HCO3 (-) (r=0.58, p=0.000), but with a negative correlation between pre-dialysis HCO3 (-) and the increment of intradialytic HCO3 (-) following hemodialysis (r=-0.46, p=0.001). In conclusion, this study shows that the impact of conventional dialysate bicarbonate concentrations ranging from 25 to 35 mEq/L is not quite different on the mild degree of predialysis acidemia, but the degree of postdialysis alkalemia is more prominent in higher bicarbonate concentrations. Base supply by hemodialysis alone does not seem to be the main factor to determine the predialysis acidosis in end-stage renal disease patients on chronic maintenance hemodialysis.
本研究旨在评估不同透析液碳酸氢盐浓度对某大学血液透析中心53例稳定血液透析患者酸碱失衡的纠正效果。研究分配了三种不同的碳酸氢盐浓度，即10例患者为25 mEq/L，30例患者为30 mEq/L，13例患者为35 mEq/L。在透析周中，对透析前后动脉血样进行血气分析，以测定pH值和血清碳酸氢盐（HCO3 (-)）浓度。所有3组患者透析前动脉HCO3 (-)的平均值均为轻度酸中毒，但组间差异无统计学意义；而透析后动脉HCO3 (-)的平均值为碱中毒，尤其是35 mEq/L组与其他两组相比更为明显。3组患者的平均血液pH值差异无统计学意义。正如预期的那样，透析前pH值与透析后pH值之间呈正相关（r = 0.45，p = 0.001），透析前HCO3 (-)与透析后HCO3 (-)之间也呈正相关（r = 0.58，p = 0.000），但透析前HCO3 (-)与血液透析后透析中HCO3 (-)的增加值呈负相关（r = -0.46，p = 0.001）。总之，本研究表明，25至35 mEq/L的传统透析液碳酸氢盐浓度对轻度透析前酸血症的影响差异不大，但较高碳酸氢盐浓度下透析后碱血症的程度更为突出。对于接受慢性维持性血液透析的终末期肾病患者，仅通过血液透析补充碱似乎不是决定透析前酸中毒的主要因素。
