Changing dialysate composition to optimize acid-base therapy

Seminars in Dialysis
John A SargentF John Gennari

Abstract

In response to rapid alkali delivery during hemodialysis, hydrogen ions (H+ ) are mobilized from body buffers and from stimulation of organic acid production in amounts sufficient to convert most of the delivered bicarbonate to CO2 and water. Release of H+ from nonbicarbonate buffers serves to back-titrate them to a more alkaline state, readying them to buffer acids that accumulate in the interval between treatments. By contrast, stimulation of organic acid production only serves to remove added bicarbonate (HCO3- ) from the body; the organic anions produced by this process are lost into the dialysate, irreversibly acidifying the patient as well as diverting metabolic activity from normal homeostasis. We have developed an analytic tool to quantify these acid-base events, which has shown that almost two-thirds of the H+ mobilized during hemodialysis comes from organic acid production when bath bicarbonate concentration ([HCO3- ]) is 32 mEq/L or higher. Using data from the hemodialysis patients we studied with our analytical model, we have simulated the effect of changing bath solute on estimated organic acid production. Our simulations demonstrate that reducing bath [HCO3- ] should decrease organic acid production, a change we p...Continue Reading

References

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Citations

Apr 3, 2019·Seminars in Dialysis·Jaime Uribarri, Man S Oh
Mar 5, 2020·The International Journal of Artificial Organs·John K LeypoldtJacek Waniewski
Jan 14, 2021·American Journal of Physiology. Renal Physiology·F John Gennari, John A Sargent
Apr 21, 2020·American Journal of Physiology. Renal Physiology·Sarah ParkMatthew K Abramowitz

Related Concepts

Acetate
Acids
Alkalies
Bicarbonates
Buffers
Carbon Dioxide
Clinical Research
Proton Pump
Hemodialysis
Metabolism

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