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Related Experiment Videos

Acid-base profile in patients on PD.

Salim Mujais1

  • 1Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA.

Kidney International. Supplement
|February 12, 2004
PubMed
Summary

Most peritoneal dialysis (PD) patients achieve normal bicarbonate levels, with acidosis corrected by dialysis. However, elevated anion gaps persist, influenced by factors like peritoneal membrane permeability in continuous ambulatory PD (CAPD).

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Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Acid-Base Balance

Background:

  • Secular trends in dialysis dose and delivery modes necessitate re-evaluating acid-base status in peritoneal dialysis (PD) patients.
  • Understanding acid-base profiles is crucial for optimizing renal replacement therapy.

Purpose of the Study:

  • To explore the steady-state acid-base profile and its determinants in patients undergoing automated PD (APD) and continuous ambulatory PD (CAPD).

Main Methods:

  • Analyzed acid-base parameters in 175 CAPD patients and 77 APD patients.
  • Assessed anion gap, serum bicarbonate, albumin, BUN, phosphate, and peritoneal permeability (4-hour D/P creatinine).

Main Results:

  • Most PD patients (62-70%) had normal serum bicarbonate; only 10-12% had acidosis (<22 mEq/L).
  • Elevated anion gaps were common, inversely related to bicarbonate and directly to albumin and phosphate.
  • In CAPD, higher anion gaps correlated with lower peritoneal permeability, an effect overridden by higher dialysate volumes in APD.

Conclusions:

  • Acidosis correction in PD is primarily achieved through continuous alkali supplementation via dialysis.
  • Serum bicarbonate in CAPD is influenced by peritoneal membrane permeability, while APD's larger dialysate volumes may mitigate this.
  • Discrepancies between acid load and dialysis dose may exist, indicated by higher albumin, BUN, and phosphate in patients with lower bicarbonate.

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