Effect of dialysate bicarbonate and sodium on blood pH in maintenance hemodialysis—A prospective study. Issue 2 (3rd September 2022)

• Record Type: Journal Article
• Authors: Sridhar, Nagaraja Rao; Chen, Ziqiang; Yu, Guan; Lambert, Judy; Muscarella, Mary; Nanjundegowda, Madan; Panesar, Mandip
• Is Part Of: Therapeutic apheresis and dialysis. Volume 27:Issue 2(2023)
• Page Start: 270
• Page End: 277
• Publication Date: 2022-09-03
• Subjects: blood pH -- dialysate bicarbonate -- dialysate sodium -- hemodialysis patients; Hemapheresis -- Periodicals; Dialysis -- Periodicals; Blood Component Removal -- Periodicals; Renal Dialysis -- Periodicals; Hémaphérèse -- Périodiques; Dialyse -- Périodiques; Sang -- Collecte et conservation -- Périodiques; 616
• DOI: 10.1111/1744-9987.13920
• Languages: English
• ISSNs: 1744-9979

Abstract

Abstract: Introduction: The validity of adjusting dialysate bicarbonate based on pre‐hemodialysis (HD) serum bicarbonate is unclear. There are no studies of the impact of dialysate sodium on blood pH. Aims: To understand the impact of dialysate bicarbonate and sodium on blood pH. Methods: Two hundred arterialized blood samples were obtained on the third session of HD with four configurations of dialysate: sodium (140, 137 mEq/L) and bicarbonate (38, 32 mEq/L). Results: The correlation between pre‐HD serum bicarbonate and pH was modest ( r = 0.6). A lower dialysate sodium ( p = 0.035) and a higher bicarbonate ( p = 0.02) associated with a higher post‐HD blood pH. The frequency of pre‐HD blood pH of <7.4 and a post‐HD blood pH of >7.5 did not differ for samples with serum bicarbonate <22, 22–26, or >26 mEq/L. Discussion/Conclusions: Adjusting dialysate buffer based on pre‐HD serum bicarbonate is unnecessary. A higher bicarbonate and lower dialysate sodium associate with post‐HD alkalemia.