Alkali delivery in chronic hemodialysis: Would more acetate be helpful?

Seminars in Dialysis
Jaime Uribarri, Man S Oh

Abstract

The dialysate alkali used in hemodialysis to replace low body alkali levels in end stage renal disease (ESRD) patients has changed over time from bicarbonate to acetate and finally back to bicarbonate with a small addition of acetate. The ideal way to replace alkali in dialysis patients remains uncertain. Elsewhere in this issue of the journal, Sargent and Gennari, who have contributed greatly to our understanding of dialysis and acid-base kinetics, suggest that decreasing the currently used concentration of bicarbonate while increasing concentration of acetate in the dialysate may be a much more physiological approach to alkali delivery during hemodialysis. These recommendations are based on results from a series of hemodialysis simulations using mathematical theoretical methods, with the assumption that acetate metabolism will be sufficiently delayed with the higher acetate dialysate and reduce the rate of correction of metabolic acidosis during dialysis. Although valuable in calling attention to the issues surrounding alkali repletion during hemodialysis, these postulations should be tested in clinical trials. We believe, however, that the available evidence suggests that the rate of gain of bicarbonate during dialysis with ...Continue Reading

References

May 1, 1977·Kidney International·N TolchinE J Lewis
Jan 1, 1987·American Journal of Nephrology·P VinayL Lapierre
Sep 1, 1985·Kidney International·R M HakimM N Gottlieb
Jan 1, 1985·American Journal of Nephrology·M S OhH J Carroll
Jan 8, 1999·The Journal of Obstetrics and Gynaecology Research·R KawashimaY Nagata
Nov 4, 2005·Artificial Organs·Kostas I SombolosTaïsir A Natse
May 28, 2013·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Francesca TentoriFriedrich K Port
May 28, 2015·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Tadashi YamamotoYoshiharu Tsubakihara
Apr 4, 2019·Seminars in Dialysis·John A SargentF J Gennari

Related Concepts

Acetate
Acids
Alkalies
Attention
Bicarbonates
Clinical Trials
Dialysis Procedure
Dialysis Solutions
Hemodialysis
Kidney Failure, Chronic

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