Jp. Brady et Ja. Hasbargen, CORRECTION OF METABOLIC-ACIDOSIS AND ITS EFFECT ON ALBUMIN IN CHRONIC-HEMODIALYSIS PATIENTS, American journal of kidney diseases, 31(1), 1998, pp. 35-40
Serum albumin concentration has been strongly associated with risk of
death in hemodialysis patients, with mortality increasing as albumin d
ecreases. Metabolic acidosis stimulates protein catabolism and decreas
es protein synthesis. A study was undertaken to investigate the effect
of increasing predialysis serum bicarbonate (HCO3) concentrations on
the nutrition of hemodialysis patients as measured by albumin and tota
l lymphocyte count (TLC). Metabolic acidosis was defined as a predialy
sis serum bicarbonate concentration of less than or equal to 18 mEq/L.
Thirty-six hemodialysis patients were enrolled in the study. Each had
been stable on hemodialysis for greater than or equal to 3 months and
each had a mean serum bicarbonate concentration of less than or equal
to 18 mEq/L on predialysis monthly laboratory values during the prece
ding 3 months. The subjects were randomized into 2 groups. The first g
roup consisted of 18 control subjects who were dialyzed on a standard
bicarbonate bath of 35 mEq/L. The second group consisted of 18 experim
ental patients who were dialyzed on a bicarbonate bath of 40 mEq/L, Su
bjects in the experimental group who had predialysis serum bicarbonate
concentrations less than 22 mEq/L after 2 weeks on the higher bicarbo
nate bath were additionally supplemented with oral sodium bicarbonate
at a dosage of 1 mEq/kg dry weight/d. Monthly predialysis laboratory v
alues were checked for all subjects and included serum electrolytes, b
lood urea nitrogen, calcium, and albumin. TLCs were obtained at the in
itiation and at the conclusion of the study. Intact parathyroid hormon
e, blood pressures, and interdialytic weight gains were also followed.
The study lasted 16 weeks; 32 subjects completed the study (16 in eac
h group). There were no statistically significant differences between
the two groups at the initiation of the study. The serum bicarbonate c
oncentrations were significantly different between the two groups at t
he end of the study (control HCO3 17.3 +/- 3.2 mEq/L v experimental HC
O3 20.2 +/- 2.9 mEq/L; P = 0.01). Serum albumin concentrations and TLC
s were not statistically different (P > 0.05) between the two groups a
t the end of the study (control albumin 3.88 +/- 0.28 g/dL v experimen
tal albumin 3.76 +/- 0.26 g/dL and control TLC 1,780.0 +/- 779.4/mm(3)
v experimental TLC 2,020.1 +/- 888.0/mm(3)). Potassium, intact parath
yroid hormone, interdialytic weight gain, blood pressures, Kt/Vs, and
protein catabolic rates did not differ. We found that the change in se
rum bicarbonate concentration was well-tolerated and was without any d
emonstrable side effects. We conclude that increasing the serum bicarb
onate concentration by 3 mEq/L for 16 weeks has no effect on the indic
ators of nutrition that we measured (serum albumin and TLC). (C) 1998
by the National Kidney Foundation, Inc.