Oral treatment of metabolic acidosis in hemodialyzed patients and the implications on the hemodynamic status.
Metabolic acidosis slowly develops during renal impairment natural evolution towards ESRD and represents an important contributing factor of CKD progression. Although, several clinical and experimental trials reported the major impact of metabolic acidosis on CKD evolution, the pathophysiology mechanism remains a matter of debate. Furthermore, international guidelines do not impose a specific treatment scheme for metabolic acidosis in CKD patients, and metabolic acidosis is not fully compensated once hemodialysis starts. Therefore, the aim of our study was to determine an adequate follow-up of metabolic acidosis therapy benefits and risks in HD patients.


METHODS
164 HD patients were evaluated according to the following protocol: bioumoral laboratory tests, the measure of different important parameters (residual diuresis, UF, BP, LVMI, volemia status). The assessed data were statistic analyzed using non-paired Student's t-test for continuous variables and chi-square (χ²) test for qualitative parameters (p-value <0.05 was considered statistically significant).


RESULTS
HD individuals were followed-up depending on their predialysis-alkaline reserve value. After therapy started, predialysis-alkaline reserve mean level increased from 19.4 mEq/L to 22.6 mEq/L (p<0.001). Furthermore, we observed a significant decrease of nitrogenous waste products values (T=10.87<1.66) and intradialytic hypotension events (p<0.001).


CONCLUSIONS
Our findings emphasize the beneficial effects of correcting metabolic acidosis using the proposed treatment scheme with direct impact on hemodynamic status improvement.
Department of Nephrology and Dialysis, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; fizij@yahoo.com.
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IA
Checheriţă
Cristiana
C
David
A
A
Ciocâlteu
I
I
Lascăr
Laura
L
Budală
D000138:Acidosis / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
D001639:Bicarbonates