Bozikas Andreas, Kiriakoutzik Iliana, Petrou Ioannis, Touroutzis Theodoros, Kitoukidi Eleni, Pisanidou Pinelopi, Vakiani Styliani, Georgilas Nikolaos, Martika Antigoni, Pangidis Panagiotis, Spaia Sofia
General Hospital of Thessaloniki "Agios Pavlos", Nephrology Department, Thessaloniki, Greece.
Hemodial Int. 2019 Apr;23(2):173-180. doi: 10.1111/hdi.12710. Epub 2019 Feb 14.
Acidemia and alkalemia, as a result of gradual depletion of the body's buffers followed by rapid repletion during hemodialysis (HD), are linked to adverse consequences. We examined the acid-base status with dialysis bath of higher bicarbonate (HC03 ) concentration or standard HC03 bath plus oral HC03 supplementation.
A total of 60 stable HD patients (pts) were evaluated according to their pre-dialysis acid-base status both before the first and the second session of the week dialyzed against standard base dialysate of 35 mmol/L. Those who presented predialysis HC03 <22 mmol/L (25 pts) were assigned to dialysis against bath of increased HC03 levels (37 mmol/L) for 2 weeks (period A) and subsequently to dialysis with the standard dialysate bath plus daily oral sodium bicarbonate at a dose of 5 g/day for 2 weeks (period B). Pre and post-dialysis acid-base status at each study period and relevant laboratory tests were recorded.
Pre-dialysis acid-base values were similar between the first and the second dialysis session. Twenty-five points had pre-dialysis pH <7.35, while 42 (the younger ones) presented pre-dialysis HC03 <22 mmol/L. After dialysis session 18 pts had pH >7.45. Comparing the two study periods, interdialytic weight was similar, pre-dialysis HC03 levels were improved with oral bicarbonate, while post-dialysis HC03 were higher during period A. Three pts could not tolerate the symptoms of alkalemia during period A.
The impact of conventional HC03 concentrations of 35 mmol/L results in a considerable degree of pre-dialysis acidemia. Increasing the HC03 in bath results in more prominent post-dialysis alkalemia, however, it is not sufficient to maintain acid-base status during the interdialytic period. Oral bicarbonate supplement at a dose of 5 g/day (divided in three daily doses) results in a more balanced acid-base status, avoiding post-dialysis alkalemia.
由于身体缓冲物质逐渐耗尽，随后在血液透析（HD）期间快速补充，导致酸血症和碱血症，这与不良后果相关。我们使用较高碳酸氢盐（HCO₃）浓度的透析液或标准HCO₃透析液加口服HCO₃补充剂来检查酸碱状态。
根据60例稳定的HD患者在一周内第一次和第二次透析前的透析前酸碱状态，对其进行评估，透析使用的是35 mmol/L的标准碱基透析液。那些透析前HCO₃<22 mmol/L的患者（25例）被分配到使用增加HCO₃水平（37 mmol/L）的透析液进行透析2周（A期），随后使用标准透析液加每日口服5 g碳酸氢钠进行透析2周（B期）。记录每个研究阶段透析前后的酸碱状态以及相关实验室检查结果。
第一次和第二次透析期间透析前的酸碱值相似。25例患者透析前pH<7.35，而42例（较年轻的患者）透析前HCO₃<22 mmol/L。透析后18例患者pH>7.45。比较两个研究阶段，透析间期体重相似，口服碳酸氢盐可改善透析前HCO₃水平，而A期透析后HCO₃更高。3例患者在A期无法耐受碱血症症状。
传统的35 mmol/L HCO₃浓度会导致相当程度的透析前酸血症。增加透析液中的HCO₃会导致更明显的透析后碱血症，然而，这不足以在透析间期维持酸碱状态。每日口服5 g（分三次服用）的碳酸氢盐补充剂可导致更平衡的酸碱状态，避免透析后碱血症。
