title: Changes in Serum Bicarbonate Levels Caused by Acetate-Containing Bicarbonate-Buffered Hemodialysis Solution: An Observational Prospective Cohort Study.
abstract: Fresenius Medical Care's NaturaLyte dialysate has been associated with increased risk of sudden cardiac death by causing metabolic alkalosis from its acetate content based on retrospective data using pre-dialysis bicarbonate levels only. The study objective was to measure inter/intra-dialytic changes in serum bicarbonate and degree of alkalosis conferred by varying concentrations of NaturaLyte bicarbonate dialysate. Thirty-nine hemodialysis patients were divided into four groups based on prescribed bicarbonate dialysate concentrations; Group 1 (N = 9): 30-32 mEq/L, Group 2 (N = 5): 33-34 mEq/L, Group 3 (N = 10): 35-36 mEq/L, Group 4 (N = 15): 37-40 mEq/L. Serial (pre-dialysis, immediate post-dialysis, 2 h post-dialysis, and 68 h post-dialysis) bicarbonate levels were measured. Mean pre-dialysis serum bicarbonate levels (representing 44 h post-dialysis levels) in all four groups were not statistically different. Pre-dialysis and 68 h post-dialysis bicarbonate levels in each group were also not significantly different. However, immediate post-dialysis and 2 h post-dialysis bicarbonate levels were significantly increased in all four groups proportional to dialysate dose. There was statistically significant inter-group bicarbonate level difference (P < 0.05) except between the first and second (P = 0.43) and second and third (P = 0.07) groups in the immediate post-dialysis period. Similar results were obtained for the 2 h post-dialysis period. High bicarbonate dialysate causes large and rapid fluctuations in serum bicarbonate levels during the intra/inter-dialytic period, which returns to baseline within 44 to 68 h after dialysis. This refutes the necessity to correct pre-dialysis acidosis with high bicarbonate dialysate since rapid equilibration is likely to occur and unnecessarily exposes patients to large shifts in their acid base balance.
authors.affiliation: The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.|Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Mandip
authors.initials: M
authors.lastname: Panesar
authors.affiliation: Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Neal
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Vaqar
authors.affiliation: Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Ivaturi
authors.affiliation: Department of Medicine, Jacobs School of Medicine, Statistics and Data Management Lab, Buffalo, New York, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gudleski
authors.affiliation: The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.
authors.forename: Mary
authors.initials: M
authors.lastname: Muscarella
authors.affiliation: The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.
authors.forename: Judy
authors.initials: J
authors.lastname: Lambert
authors.affiliation: The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.|Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
authors.forename: Winnie
authors.initials: W
authors.lastname: Su
authors.affiliation: The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Murray
mesh_terms: D000085:Acetates / Q000494:pharmacology*; D001639:Bicarbonates / Q000097:blood* / Q000494:pharmacology*; D015331:Cohort Studies; D005260:Female; D015312:Hemodialysis Solutions / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000085:Acetates; D001639:Bicarbonates; D015312:Hemodialysis Solutions
keywords: Acetate; Acid-base balance; Bicarbonate; Hemodialysis; Metabolic alkalosis