Acid-base homeostasis with the high convective dialysis treatments

The feedback between metabolic acid production and dialytic base gain ensures a neutral acid-base balance in patients on renal replacement therapy (RRT). Despite acid not accumulating continuously, clinical studies demonstrated that normalizing pre-dialysis serum bicarbonate results in nutritional and osteodystrophy improvements. Full correction of acidosis is not an easy task in dialysis patients because it depends on both some intrinsic characteristics of patients and dialysis prescriptions. Thus, a large variation in the result is often recorded among dialysis populations and in acid-base studies. Highly convective dialysis treatments make the individualization of dialytic parameters easier than conventional dialysis. Up to now, few clinical data have been published. However, knowledge of and the quantification of the kinetic phenomena that govern the buffer transfer during a session of these high performance treatments can provide a rational approach to the optimal dialysis prescription.