Sridhar Nagaraja Rao, Chen Ziqiang, Yu Guan, Lambert Judy, Muscarella Mary, Nanjundegowda Madan, Panesar Mandip
Department of Nephrology, Buffalo Medical Group, Buffalo, New York, USA.
Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Ther Apher Dial. 2023 Apr;27(2):270-277. doi: 10.1111/1744-9987.13920. Epub 2022 Sep 3.
The validity of adjusting dialysate bicarbonate based on pre-hemodialysis (HD) serum bicarbonate is unclear. There are no studies of the impact of dialysate sodium on blood pH.
To understand the impact of dialysate bicarbonate and sodium on blood pH.
Two hundred arterialized blood samples were obtained on the third session of HD with four configurations of dialysate: sodium (140, 137 mEq/L) and bicarbonate (38, 32 mEq/L).
The correlation between pre-HD serum bicarbonate and pH was modest (r = 0.6). A lower dialysate sodium (p = 0.035) and a higher bicarbonate (p = 0.02) associated with a higher post-HD blood pH. The frequency of pre-HD blood pH of <7.4 and a post-HD blood pH of >7.5 did not differ for samples with serum bicarbonate <22, 22-26, or >26 mEq/L.
DISCUSSION/CONCLUSIONS: Adjusting dialysate buffer based on pre-HD serum bicarbonate is unnecessary. A higher bicarbonate and lower dialysate sodium associate with post-HD alkalemia.
基于血液透析前血清碳酸氢盐水平调整透析液碳酸氢盐的有效性尚不清楚。目前尚无关于透析液钠对血液pH值影响的研究。
了解透析液碳酸氢盐和钠对血液pH值的影响。
在血液透析的第三阶段采集了200份动脉化血样，透析液有四种配置：钠（140、137 mEq/L）和碳酸氢盐（38、32 mEq/L）。
血液透析前血清碳酸氢盐与pH值之间的相关性一般（r = 0.6）。较低的透析液钠（p = 0.035）和较高的碳酸氢盐（p = 0.02）与血液透析后较高的血液pH值相关。血清碳酸氢盐<22、22 - 26或>26 mEq/L的样本，血液透析前血液pH值<7.4且血液透析后血液pH值>7.5的频率无差异。
讨论/结论：基于血液透析前血清碳酸氢盐水平调整透析液缓冲液没有必要。较高的碳酸氢盐和较低的透析液钠与血液透析后碱血症相关。
