The choice of dialysate bicarbonate: do different concentrations make a difference?

Area of Science:

• Nephrology
• Internal Medicine
• Biochemistry

Background:

• Metabolic acidosis is a frequent complication of chronic kidney disease (CKD).
• Acidosis in CKD is associated with increased morbidity, hospitalization, and mortality.
• Acid-base homeostasis in hemodialysis patients is influenced by multiple factors.

Purpose of the Study:

• To review the effects of dialysate bicarbonate concentrations on hard outcomes in hemodialysis patients.
• To highlight the importance of acid-base balance in CKD management.
• To provide guidance on predialysis serum bicarbonate targets.

Main Methods:

• Literature review focusing on dialysate bicarbonate and mortality.
• Analysis of factors influencing acid-base balance during hemodialysis.
• Examination of current recommendations for predialysis serum bicarbonate levels.

Main Results:

• No randomized studies currently exist on dialysate bicarbonate concentrations and hard outcomes.
• Metabolic alkalosis post-dialysis may be linked to adverse clinical outcomes.
• Current targets for predialysis serum bicarbonate are based on observational data and expert opinion.

Conclusions:

• Maintaining predialysis serum bicarbonate at or above 22 mmol/l is recommended.
• Further research is needed to clarify the impact of acid-base status on survival in hemodialysis patients.
• Clinicians should monitor patients with significant acid-base deviations.