title: Con: Higher serum bicarbonate in dialysis patients is protective.
abstract: Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival. Conversely, a high bicarbonate serum concentration is associated with poor nutritional status and lower survival. It is likely that mild acidosis results from a dietary acid load linked to animal protein intake. In contrast, a high bicarbonate concentration in patients treated with dialysis could result mainly from an insufficient dietary acid load, i.e. low protein intake. Therefore, a high pre-dialysis serum bicarbonate concentration should prompt nephrologists to carry out nutritional investigations to detect insufficient dietary protein intake. In any case, a high bicarbonate concentration should be neither a goal of dialysis therapy nor an index of adequate dialysis, whereas mild acidosis could be considered as an indicator of appropriate protein intake.
authors.affiliation: Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 33076, France AURAD Aquitaine, Gradignan 33170, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.affiliation: Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 33076, France Unité INSERM 1026 Bioingénierie tissulaire, Université de Bordeaux, Bordeaux 33000, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Rigothier
authors.affiliation: Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 33076, France Unité INSERM 1026 Bioingénierie tissulaire, Université de Bordeaux, Bordeaux 33000, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
mesh_terms: D000138:Acidosis / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control; D001639:Bicarbonates / Q000097:blood*; D015314:Dialysis Solutions; D005440:Fluid Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000517:prevention & control*; D006435:Renal Dialysis
chemical_list: D001639:Bicarbonates; D015314:Dialysis Solutions
keywords: chronic kidney disease; dialysis; haemodialysis; metabolic acidosis; peritoneal dialysis