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Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments.

ABSTRACT: Recent studies have suggested benefits for time-dependent dialysate bicarbonate concentrations (D_bic) during hemodialysis (HD). In this clinical trial, we compared for the first time in the same HD patients the effects of time-dependent changes with constant D_bic on acid-base and uremic solute kinetics. Blood acid-base and uremic solute concentration were measured in twenty chronic HD patients during 4-h treatments with A) constant D_bic of 35 mmol/L; B) D_bic of 35 mmol/L then 30 mmol/L; and C) D_bic of 30 mmol/L then 35 mmol/L (change of D_bic after two hours during Treatments B and C). Arterial blood samples were obtained predialysis, every hour during HD and one hour after HD, during second and third treatments of the week with each D_bic concentration profile. Blood bicarbonate concentration (blood [HCO₃]) during Treatment C was lower only during the first three HD hours than in Treatment A. Overall blood [HCO₃] was reduced during Treatment B in comparison to Treatment A at each time points. We conclude that a single change D_bic in the middle of HD can alter the rate of change in blood [HCO₃] and pH during HD; time-dependent D_bic had no influence on uremic solute kinetics.

SUBMITTER: Wieliczko M

PROVIDER: S-EPMC10822843 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments.

Wieliczko Monika M Twardowska-Kawalec Malgorzata M Debowska Malgorzata M Pietribiasi Mauro M Bialonczyk Urszula U Waniewski Jacek J Leypoldt John K JK Matuszkiewicz-Rowinska Joanna J Malyszko Jolanta J

Scientific reports 20240128 1

Recent studies have suggested benefits for time-dependent dialysate bicarbonate concentrations (Dbic) during hemodialysis (HD). In this clinical trial, we compared for the first time in the same HD patients the effects of time-dependent changes with constant Dbic on acid-base and uremic solute kinetics. Blood acid-base and uremic solute concentration were measured in twenty chronic HD patients during 4-h treatments with A) constant Dbic of 35 mmol/L; B) Dbic ...[more]

PMID: 38281975

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Project description:BackgroundHypertension is associated with increased morbidity and mortality in hemodialysis patients. Existing recommendations suggest reduction of sodium load, but the effect of dialysate sodium on blood pressure (BP) is not fully elucidated. The aim of the present study is to investigate the effect of different dialysate sodium concentrations on 72-h ambulatory BP in hemodialysis patients.MethodsThis prospective study included patients on standard thrice-weekly hemodialysis. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/L, followed consecutively by another six sessions with dialysate sodium of 139 meq/L and, finally, six sessions with dialysate sodium of 141 meq/L. At the start of the sixth hemodialysis session on each sodium concentration, 72-h ABPM was performed over the long interdialytic interval to evaluate ambulatory systolic and diastolic BP (SBP and DBP) during the overall 72-h, different 24-h, daytime and night-time periods.ResultsTwenty-five patients were included in the final analysis. A significant increase in the mean 72-h SBP was observed with higher dialysate sodium concentrations (124.8 ± 16.6 mmHg with 137 meq/L vs 126.3 ± 17.5 mmHg with 139 meq/L vs 132.3 ± 19.31 mmHg with 141 meq/L, P = 0.002). Similar differences were noted for DBP; 72-h DBP was significantly higher with increasing dialysate sodium concentrations (75.1 ± 11.3 mmHg with 137 meq/L vs 76.3 ± 13.7 mmHg with 139 meq/L vs 79.5 ± 13.9 mmHg with 141 meq/L dialysate sodium, P = 0.01). Ambulatory BP during the different 24-h intervals, daytime and night-time periods was also progressively increasing with increasing dialysate sodium concentration.ConclusionThis pilot study showed a progressive increase in ambulatory BP with higher dialysate sodium concentrations. These findings support that lower dialysate sodium concentration may help towards better BP control in hemodialysis patients.

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Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments.

Publications

Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments.

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