Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland.
Ren Fail. 2022 Dec;44(1):1090-1097. doi: 10.1080/0886022X.2022.2094805.
Abnormalities in blood bicarbonates (HCO) concentration are a common finding in patients with chronic kidney disease, especially at the end-stage renal failure. Initiating of hemodialysis does not completely solve this problem. The recommendations only formulate the target concentration of ≥22 mmol/L before hemodialysis but do not guide how to achieve it. The aim of the study was to assess the acid-base balance in everyday practice, the effect of hemodialysis session and possible correlations with clinical and biochemical parameters in stable hemodialysis patients.
We enrolled 75 stable hemodialysis patients (mean age 65.5 years, 34 women), from a single Department of Nephrology. We assessed blood pressure, and acid-base balance parameters before and after mid-week hemodialysis session.
We found significant differences in pH, HCO pCO, lactate before and after HD session in whole group ( < 0.001; < 0.001; < 0.001; = 0.001, respectively). Buffer bicarbonate concentration had only statistically significant effect on the bicarbonate concentration after dialysis ( < 0.001). Both pre-HD acid-base parameters and post-HD pH were independent from buffer bicarbonate content. We observed significant inverse correlations between change in the serum bicarbonates and only two parameters: pH and HCO before hemodialysis ( = 0.013; < 0.001, respectively).
Despite the improvement in hemodialysis techniques, acid-base balance still remains a challenge. The individual selection of bicarbonate in bath, based on previous single tests, does not improve permanently the acid-base balance in the population of hemodialysis patients. New guidelines how to correct acid-base disorders in hemodialysis patients are needed to have less 'acidotic' patients before hemodialysis and less 'alkalotic' patients after the session.
在慢性肾脏病患者中，血碳酸氢盐（HCO）浓度异常是一种常见现象，尤其是在终末期肾衰竭患者中。开始血液透析并不能完全解决这个问题。建议只规定血液透析前的目标浓度≥22mmol/L，但不指导如何达到这一目标。本研究旨在评估稳定血液透析患者日常实践中的酸碱平衡，血液透析治疗的影响以及与临床和生化参数的可能相关性。
我们纳入了来自单个肾病科的 75 名稳定血液透析患者（平均年龄 65.5 岁，34 名女性）。我们评估了整个组在中周血液透析治疗前后的血压和酸碱平衡参数。
我们发现整个组在 HD 治疗前后的 pH、HCO3-、pCO2 和乳酸水平均有显著差异（均<0.001；均<0.001；均<0.001；=0.001）。缓冲碳酸氢盐浓度仅对透析后碳酸氢盐浓度有统计学显著影响（<0.001）。透析前的酸碱参数和透析后的 pH 均与缓冲碳酸氢盐含量无关。我们观察到血清碳酸氢盐的变化与仅两个参数呈显著负相关：透析前的 pH 和 HCO3-（=0.013；<0.001）。
尽管血液透析技术有所改进，但酸碱平衡仍然是一个挑战。根据之前的单次测试，在浴中选择个体化的碳酸氢盐并不能永久性地改善血液透析患者群体的酸碱平衡。需要新的指南来指导血液透析患者酸碱紊乱的纠正，以减少血液透析前的“酸中毒”患者和血液透析后的“碱中毒”患者。
