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Modeling acid-base balance during continuous kidney replacement therapy.

John K Leypoldt1,2, Mauro Pietribiasi3, Jorge Echeverri4

  • 1Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland. kenleypoldt@gmail.com.

Journal of Clinical Monitoring and Computing
|January 3, 2021
PubMed
Summary
This summary is machine-generated.

Using a mathematical model, this study found that bicarbonate in dialysis fluids during continuous kidney replacement therapy causes minor blood carbon dioxide and pH changes. Operating conditions like fluid rate and concentration significantly influence these acid-base balance effects.

Keywords:
Acid–base of bloodAcute kidney injuryBicarbonateCarbon dioxideDialysis fluidKidney replacement therapySubstitution fluid

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Area of Science:

  • Nephrology
  • Biomedical Engineering
  • Clinical Chemistry

Background:

  • Bicarbonate-containing fluids in continuous kidney replacement therapy (CKRT) may increase blood carbon dioxide.
  • Technical parameters influencing these acid-base changes during CKRT are not well understood.

Purpose of the Study:

  • To predict blood acid-base composition changes during CKRT using a mathematical model.
  • To clarify the technical parameters governing carbon dioxide and pH shifts in blood during CKRT.

Main Methods:

  • Developed a mathematical model of blood acid-base chemistry.
  • Simulated continuous veno-venous hemofiltration (CVVH) and continuous veno-venous hemodiafiltration (CVVHDF) using the model.
  • Analyzed predicted blood composition within and exiting the extracorporeal circuit.

Main Results:

  • CVVH with 32 mEq/L bicarbonate fluid at 2 L/h infusion and 200 mL/min blood flow caused modest increases in plasma bicarbonate (+2.0 mEq/L) and PCO2 (+4.4 mmHg).
  • Relative increases in bicarbonate (9.7%) and PCO2 (8.2%) did not significantly alter blood pH exiting the circuit.
  • Higher fluid rates increased acid-base changes, while higher blood flow or lower bicarbonate concentration (22 mEq/L) reduced them.

Conclusions:

  • The mathematical model accurately predicts acid-base changes during CKRT.
  • Operating parameters like fluid infusion rate, blood flow rate, and bicarbonate concentration are key determinants of acid-base balance during CKRT.
  • CVVHDF showed similar but less pronounced acid-base changes compared to CVVH under comparable conditions.