The Journal of Practical Medicine >

2024 , Vol. 40 >Issue 18: 2520 - 2524

DOI: https://doi.org/10.3969/j.issn.1006-5725.2024.18.002

Clinical Advances

Advances in research on optimal dialysate bicarbonate concentration for maintenance hemodialysis patients

  • Jingfang WAN ,
  • Kehong. CHEN
Expand
  • Department of Nephrology，Daping Hospital，Army Medical University，Chongqing 400042，China

Received date: 2024-05-22

  Online published: 2024-09-30

Fold

Abstract

Metabolic acidosis is a prevalent complication in patients undergoing maintenance hemodialysis （MHD）. The maintenance of acid-base balance in MHD patients primarily relies on the total alkali supply in the dialysate. Achieving an optimal concentration of dialysate bicarbonate （DBIC） is crucial to prevent metabolic acidosis before subsequent hemodialysis sessions while avoiding metabolic alkalosis after the current session. Inadequate correction or overcorrection of pre-dialysis metabolic acidosis has been associated with unfavorable patient outcomes； however， there is currently a lack of guidelines or expert consensus regarding DBIC concentration. This study addresses the epidemiology of metabolic acidosis in MHD patients， explores the relationship between DBIC concentration and acid-base disorders， and discusses recent advancements in determining the ideal DBIC concentration， providing valuable insights for formulating scientifically sound and personalized DBIC dialysis prescriptions.

Key words： maintenance hemodialysis， dialysate bicarbonate， artificial intelligence; metabolic acidosis; metabolic alkalosis

Cite this article

Jingfang WAN , Kehong. CHEN . Advances in research on optimal dialysate bicarbonate concentration for maintenance hemodialysis patients[J]. The Journal of Practical Medicine, 2024 , 40(18) : 2520 -2524 . DOI: 10.3969/j.issn.1006-5725.2024.18.002

References

1 MATSUSHITA K， BALLEW S H， WANG A Y， et al. Epidemiology and risk of cardiovascular disease in populations with chronic kidney disease［J］. Nat Rev Nephrol， 2022，18（11）： 696-707.
2 LIYANAGE T， NINOMIYA T， JHA V， et al. Worldwide access to treatment for end-stage kidney disease： A systematic review［J］. Lancet， 2015，385（9981）： 1975-1982.
3 BASILE C， ROSSI L， LOMONTE C. The choice of dialysate bicarbonate： Do different concentrations make a difference？［J］. Kidney Int， 2016，89（5）： 1008-1015.
4 GOUTHAM K， HARICHANDRAKUMAR K T， DHANIN P， et al. Persistent Metabolic Acidosis on Regular Hemodialysis or Peritoneal Dialysis［J］. Indian J Nephrol， 2019，29（2）： 84-89.
5 SILVA A， STROGOFF-DE-MATOS J P， LUGON J R. Metabolic acidosis in hemodialysis： A neglected problem in Brazil［J］. J Bras Nefrol， 2020，42（3）： 323-329.
6 YAMAMOTO T， SHOJI S， YAMAKAWA T， et al. Predialysis and Postdialysis pH and Bicarbonate and Risk of All-Cause and Cardiovascular Mortality in Long-term Hemodialysis Patients［J］. Am J Kidney Dis， 2015，66（3）： 469-478.
7 Di IORIO B R， BELLASI A， RAPHAEL K L， et al. Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease： The UBI Study［J］. J Nephrol， 2019，32（6）： 989-1001.
8 TANGRI N， MATHUR V， REAVEN N， et al. Relationship between Metabolic Acidosis and Chronic Kidney Disease Progression across Racial and Ethnic Groups： An Observational， Retrospective Cohort Study［J］. Am J Nephrol， 2022，53（8/9）： 603-613.
9 刘梅， 莫曼秋， 谭琳， 等. 单中心急性肾损伤的短期预后调查分析［J］. 实用医学杂志， 2022，38（1）： 101-105.
10 NOCE A， MARRONE G， WILSON J G， et al. Nutritional Approaches for the Management of Metabolic Acidosis in Chronic Kidney Disease［J］. Nutrients， 2021，13（8）： 2534.
11 WANG K， LIU Q， TANG M， et al. Chronic kidney disease-induced muscle atrophy： Molecular mechanisms and promising therapies［J］. Biochem Pharmacol， 2023，208： 115407.
12 REZENDE L R， SOUZA P B， PEREIRA G， et al. Metabolic acidosis in hemodialysis patients： A review［J］. J Bras Nefrol， 2017，39（3）： 305-311.
13 TANGRI N， REAVEN N L， FUNK S E， et al. Metabolic acidosis is associated with increased risk of adverse kidney outcomes and mortality in patients with non-dialysis dependent chronic kidney disease： An observational cohort study［J］. BMC Nephrol， 2021，22（1）： 185.
14 ABRAMOWITZ M K. Bicarbonate Balance and Prescription in ESRD［J］. J Am Soc Nephrol， 2017，28（3）： 726-734.
15 BOCK L， KEIL A， FLURY S， et al. Treatment of Metabolic Acidosis in Hemodialysis Patients Is Biased by Type of Vascular Access［J］. Kidney Int Rep， 2022，7（7）： 1694-1698.
16 THORNLEY-BROWN D， SAHA M. Dialysate content and risk of sudden cardiac death［J］. Curr Opin Nephrol Hypertens， 2015，24（6）： 557-562. doi:10.1097/mnh.0000000000000177
17 LOWRIE E G， LEW N L. Death risk in hemodialysis patients： The predictive value of commonly measured variables and an evaluation of death rate differences between facilities［J］. Am J Kidney Dis， 1990，15（5）： 458-482.
18 KOPPLE J D， MEHROTRA R， SUPPASYNDH O， et al. Observations with regard to the National Kidney Foundation K/DOQI clinical practice guidelines concerning serum transthyretin in chronic renal failure［J］. Clin Chem Lab Med， 2002，40（12）： 1308-1312. doi:10.1515/cclm.2002.225
19 URIBARRI J. K/DOQI guidelines for bone metabolism and disease in chronic kidney disease patients： Some therapeutic implications［J］. Semin Dial， 2004，17（5）： 349-350. doi:10.1111/j.0894-0959.2004.17354.x
20 LOCATELLI F， FOUQUE D， HEIMBURGER O， et al. Nutritional status in dialysis patients： A European consensus［J］. Nephrol Dial Transplant， 2002，17（4）： 563-572.
21 国家卫生健康委. 血液净化标准操作规程（2021版）［EB/OL］. （2021-11-09）［2024-05-01］..
22 SAHATHEVAN S， KHOR B H， NG H M， et al. Understanding Development of Malnutrition in Hemodialysis Patients： A Narrative Review［J］. Nutrients， 2020，12（10）： 3147.
23 WU D Y， SHINABERGER C S， REGIDOR D L， et al. Association between serum bicarbonate and death in hemodialysis patients： Is it better to be acidotic or alkalotic？［J］. Clin J Am Soc Nephrol， 2006，1（1）： 70-78. doi:10.2215/cjn.00010505
24 MUDUNURU S A， NAVARRETE J， O'NEILL W C. Metabolic alkalosis in hemodialysis patients［J］. Semin Dial， 2023，36（1）： 24-28. doi:10.1111/sdi.13068
25 CHANG K Y， KIM H W， KIM W J， et al. The impact of high serum bicarbonate levels on mortality in hemodialysis patients［J］. Korean J Intern Med， 2017，32（1）： 109-116.
26 TENTORI F， KARABOYAS A， ROBINSON B M， et al. Association of dialysate bicarbonate concentration with mortality in the Dialysis Outcomes and Practice Patterns Study （DOPPS）［J］. Am J Kidney Dis， 2013，62（4）： 738-746. doi:10.1053/j.ajkd.2013.03.035
27 WAN J， LIN J， WANG W， et al. Relationship between Dialysate Bicarbonate Concentration and All-Cause Mortality in Hemodialysis Patients［J］. Kidney Blood Press Res， 2023，48（1）： 460-467.
28 BASILE C， LIBUTTI P， DI TURO A L， et al. Effect of dialysate calcium concentrations on parathyroid hormone and calcium balance during a single dialysis session using bicarbonate hemodialysis： a crossover clinical trial［J］. Am J Kidney Dis， 2012，59（1）： 92-101. doi:10.1053/j.ajkd.2011.08.033
29 JOHN G F. Very low and high predialysis serum bicarbonate levels are risk factors for mortality： what are the Appropriate Interventions？［J］. Semin Dial， 2010，23（3）： 253-257.
30 PARK S， PAREDES W， CUSTODIO M， et al. Intradialytic acid-base changes and organic anion production during high versus low bicarbonate hemodialysis［J］. Am J Physiol Renal Physiol， 2020，318（6）： F1418-F1429.
31 PIETRIBIASI M， WANIEWSKI J， LEYPOLDT J K. Mathematical modelling of bicarbonate supplementation and acid-base chemistry in kidney failure patients on hemodialysis［J］. PLoS One， 2023，18（2）： e282104.
32 LAW S， DAVENPORT A. The effect of changing dialysate bicarbonate concentration on serum bicarbonate， body weight and normalized nitrogen appearance rate［J］. Artif Organs， 2023，47（5）： 891-897.
33 MONTAGUD-MARRAHI E， BROSETA J， RODRIGUEZ-ESPINOSA D， et al. Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration［J］. Clin Kidney J， 2021，14（3）： 1004-1013.
34 CUADRADO E， BROSETA J J， RODRIGUEZ-ESPINOSA D， et al. Tailoring the dialysate bicarbonate eliminates pre-dialysis acidosis and post-dialysis alkalosis［J］. Clin Kidney J， 2022，15（10）： 1946-1951.
35 WIELICZKO M， TWARDOWSKA-KAWALEC M， DEBOWSKA M， et al. Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments［J］. Sci Rep， 2024，14（1）： 2321. doi:10.1038/s41598-024-52757-2
36 BARBIERI C， MOLINA M， PONCE P， et al. An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients［J］. Kidney Int， 2016，90（2）： 422-429.
37 OHARA T， IKEDA H， SUGITANI Y， et al. Artificial intelligence supported anemia control system （AISACS） to prevent anemia in maintenance hemodialysis patients［J］. Int J Med Sci， 2021，18（8）： 1831-1839.
38 INOUE H， OYA M， AIZAWA M， et al. Predicting dry weight change in Hemodialysis patients using machine learning［J］. BMC Nephrol， 2023，24（1）： 196.
39 KIM H R， BAE H J， JEON J W， et al. A novel approach to dry weight adjustments for dialysis patients using machine learning［J］. PLoS One， 2021，16（4）： e250467.
40 SONG W T， CHEN C C， YU Z W， et al. An effective AI model for automatically detecting arteriovenous fistula stenosis［J］. Sci Rep， 2023，13（1）： 17659.
41 LEE H， MOON S J， KIM S W， et al. Prediction of intradialytic hypotension using pre-dialysis features-a deep learning-based artificial intelligence model［J］. Nephrol Dial Transplant， 2023，38（10）： 2310-2320.
42 HUESO M， VELLIDO A， MONTERO N， et al. Artificial Intelligence for the Artificial Kidney： Pointers to the Future of a Personalized Hemodialysis Therapy［J］. Kidney Dis （Basel）， 2018，4（1）： 1-9.
Options
Outlines

/

〈 〉