Persistent Metabolic Acidosis on Regular Hemodialysis or Peritoneal Dialysis

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Chemistry

Background:

• Metabolic acidosis negatively impacts chronic kidney disease (CKD) patients, affecting bone, endocrine, and nutritional status.
• Routine bicarbonate monitoring is often overlooked in dialysis patients, despite KDOQI guidelines recommending levels ≥22 mEq/L.

Purpose of the Study:

• To assess predialysis serum bicarbonate levels in hemodialysis (HD) and peritoneal dialysis (PD) patients.
• To evaluate the effectiveness of HD in correcting metabolic acidosis post-treatment.
• To compare acidosis correction between HD and PD modalities.

Main Methods:

• Serum bicarbonate levels were measured predialysis and postdialysis in 100 HD and 41 PD patients.
• Patient dialysis schedules and dialysate bicarbonate concentrations were recorded.
• Statistical analysis was performed to compare bicarbonate levels between groups and time points.

Main Results:

• 73% of HD patients and 12% of PD patients had predialysis bicarbonate <22 mEq/L.
• 41% of HD patients remained below target levels even after hemodialysis.
• While HD increased bicarbonate, 41% of patients still had acidosis post-treatment; PD showed significantly lower persistent acidosis.

Conclusions:

• A high percentage of hemodialysis patients suffer from uncorrected metabolic acidosis, even immediately post-dialysis.
• Current hemodialysis prescriptions may be inadequate for optimal acidosis correction.
• Peritoneal dialysis appears more effective than hemodialysis in managing metabolic acidosis in CKD patients.