Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study
Abstract Background Metabolic acidosis is common in hemodialysis (HD) patients. The KDOQI guidelines therapeutic goal is pre-dialysis HCO3 − ≥ 22 mmol/L. The aim of the study was to evaluate an individualized HCO3 − hemodialysis prescription as a preventing factor of metabolic changes. Methods Twent...
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doaj-e7da184a0d284adbba9149a73516e1a82020-11-25T04:00:54ZengBMCRenal Replacement Therapy2059-13812020-11-01611510.1186/s41100-020-00302-yChanging the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective studyRita Valério Alves0Hernâni Gonçalves1Karina Lopes2Flora Sofia3Ana Vila Lobos4Nephrology Department, Centro Hospitalar Médio TejoNephrology Department, Centro Hospitalar Médio TejoNephrology Department, Centro Hospitalar Médio TejoNephrology Department, Centro Hospitalar Médio TejoNephrology Department, Centro Hospitalar Médio TejoAbstract Background Metabolic acidosis is common in hemodialysis (HD) patients. The KDOQI guidelines therapeutic goal is pre-dialysis HCO3 − ≥ 22 mmol/L. The aim of the study was to evaluate an individualized HCO3 − hemodialysis prescription as a preventing factor of metabolic changes. Methods Twenty-four-month prospective study of patients on online high-flux hemodiafiltration. Every 3 months, HCO3 − blood levels were analyzed and hemodialysis HCO3 − was changed using the following rules: HCO3 − > 30 mmol/L: reduce 4 mmol/L HCO3 − HCO3 − ≥ 25 mmol/L: reduce 2 mmol/L HCO3 − 20 mmol/L < HCO3 − < 25 mmol/L: no change HCO3 − ≤ 20 mmol/L: increase 2 mmol/L HCO3 − HCO3 − < 18 mmol/L: increase 4 mmol/L HCO3 − Data collected comprised demographic information, renal disease etiology, comorbidities, HD treatment information, and lab results. Statistical analysis was performed using SPSS. Results Thirty-one patients were enrolled and completed the follow-up period. At baseline, average serum pH was 7.38 ± 0.06, serum HCO3 − 25.92 ± 1.82 mmol/L, and every patient had a 32 mmol/L dialytic HCO3 − prescription. At time point 9, average serum HCO3 − was 23.87 ± 1.93 mmol/L and 58% of the patients had a dialytic HCO3 − prescription of 28 mmol/L. Serum HCO3 − differed with statistical significance during time and approached the reference serum HCO3 − (23 mmol/L) that we have defined as ideal. Through time, the HCO3 − prescription deviated more from the 32 mmol/L initial prescription that was defined as standard. Conclusions Our findings suggest that the standard HCO3 − prescription of 32 mmol/L should be rethought, as an individualized HCO3 − prescription could be beneficial for the patient.http://link.springer.com/article/10.1186/s41100-020-00302-yHemodialysisBicarbonateMetabolic acidosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rita Valério Alves Hernâni Gonçalves Karina Lopes Flora Sofia Ana Vila Lobos |
spellingShingle |
Rita Valério Alves Hernâni Gonçalves Karina Lopes Flora Sofia Ana Vila Lobos Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study Renal Replacement Therapy Hemodialysis Bicarbonate Metabolic acidosis |
author_facet |
Rita Valério Alves Hernâni Gonçalves Karina Lopes Flora Sofia Ana Vila Lobos |
author_sort |
Rita Valério Alves |
title |
Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study |
title_short |
Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study |
title_full |
Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study |
title_fullStr |
Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study |
title_full_unstemmed |
Changing the paradigm of bicarbonate (HCO3 −) hemodialysis prescription in Portugal: a 24-month prospective study |
title_sort |
changing the paradigm of bicarbonate (hco3 −) hemodialysis prescription in portugal: a 24-month prospective study |
publisher |
BMC |
series |
Renal Replacement Therapy |
issn |
2059-1381 |
publishDate |
2020-11-01 |
description |
Abstract Background Metabolic acidosis is common in hemodialysis (HD) patients. The KDOQI guidelines therapeutic goal is pre-dialysis HCO3 − ≥ 22 mmol/L. The aim of the study was to evaluate an individualized HCO3 − hemodialysis prescription as a preventing factor of metabolic changes. Methods Twenty-four-month prospective study of patients on online high-flux hemodiafiltration. Every 3 months, HCO3 − blood levels were analyzed and hemodialysis HCO3 − was changed using the following rules: HCO3 − > 30 mmol/L: reduce 4 mmol/L HCO3 − HCO3 − ≥ 25 mmol/L: reduce 2 mmol/L HCO3 − 20 mmol/L < HCO3 − < 25 mmol/L: no change HCO3 − ≤ 20 mmol/L: increase 2 mmol/L HCO3 − HCO3 − < 18 mmol/L: increase 4 mmol/L HCO3 − Data collected comprised demographic information, renal disease etiology, comorbidities, HD treatment information, and lab results. Statistical analysis was performed using SPSS. Results Thirty-one patients were enrolled and completed the follow-up period. At baseline, average serum pH was 7.38 ± 0.06, serum HCO3 − 25.92 ± 1.82 mmol/L, and every patient had a 32 mmol/L dialytic HCO3 − prescription. At time point 9, average serum HCO3 − was 23.87 ± 1.93 mmol/L and 58% of the patients had a dialytic HCO3 − prescription of 28 mmol/L. Serum HCO3 − differed with statistical significance during time and approached the reference serum HCO3 − (23 mmol/L) that we have defined as ideal. Through time, the HCO3 − prescription deviated more from the 32 mmol/L initial prescription that was defined as standard. Conclusions Our findings suggest that the standard HCO3 − prescription of 32 mmol/L should be rethought, as an individualized HCO3 − prescription could be beneficial for the patient. |
topic |
Hemodialysis Bicarbonate Metabolic acidosis |
url |
http://link.springer.com/article/10.1186/s41100-020-00302-y |
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