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Leypoldt JK, Pietribiasi M, Debowska M, Wieliczko M, Twardowska-Kawalec M, Malyszko J, Waniewski J. Evaluating hydrogen ion mobilization during hemodialysis using only predialysis and postdialysis blood bicarbonate concentrations. Int J Artif Organs 2024:3913988241268026. [PMID: 39149923 DOI: 10.1177/03913988241268026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
INTRODUCTION The hydrogen ion (H+) mobilization model has been previously shown to provide a quantitative description of intradialytic changes in blood bicarbonate (HCO3) concentration during hemodialysis (HD). The current study evaluated the accuracy of different methods for estimating the H+ mobilization parameter (Hm) from this model. METHODS The study compared estimates of the H+ mobilization parameter using predialysis, hourly during the HD treatment, and postdialysis blood HCO3 concentrations (Hm-full2) with those determined using only predialysis and postdialysis blood HCO3 concentrations assuming steady state conditions (Hm-SS2) during the midweek treatment in 24 chronic HD patients treated thrice weekly. RESULTS Estimated Hm-full2 values (0.163 ± 0.079 L/min [mean ± standard deviation]) were higher than, but not statistically different (p = 0.067) from, those of Hm-SS2 (0.152 ± 0.065 L/min); the values of Hm-full2 and Hm-SS2 were highly correlated with a correlation coefficient of 0.948 and a mean difference that was small (0.011 L/min). Further, the H+ mobilization parameter values calculated using only predialysis and postdialysis blood HCO3 concentrations during the first and third HD treatments of the week were not different from those calculated during the midweek treatment. CONCLUSIONS The H+ mobilization model can be used to provide estimates of the H+ mobilization parameter without the need to measure hourly intradialytic blood HCO3 concentrations.
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Affiliation(s)
- John K Leypoldt
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warszawa, Poland
| | - Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warszawa, Poland
| | - Malgorzata Debowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warszawa, Poland
| | | | | | | | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warszawa, Poland
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Molnar AO, Killin L, Bota S, McArthur E, Dixon SN, Garg AX, Harris C, Thompson S, Tennankore K, Blake PG, Bohm C, MacRae J, Silver SA. Association Between the Dialysate Bicarbonate and the Pre-dialysis Serum Bicarbonate Concentration in Maintenance Hemodialysis: A Retrospective Cohort Study. Can J Kidney Health Dis 2024; 11:20543581241256774. [PMID: 38827142 PMCID: PMC11141227 DOI: 10.1177/20543581241256774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
Background It is unclear whether the use of higher dialysate bicarbonate concentrations is associated with clinically relevant changes in the pre-dialysis serum bicarbonate concentration. Objective The objective is to examine the association between the dialysate bicarbonate prescription and the pre-dialysis serum bicarbonate concentration. Design This is a retrospective cohort study. Setting The study was performed using linked administrative health care databases in Ontario, Canada. Patients Prevalent adults receiving maintenance in-center hemodialysis as of April 1, 2020 (n = 5414) were included. Measurements Patients were grouped into the following dialysate bicarbonate categories at the dialysis center-level: individualized (adjustment based on pre-dialysis serum bicarbonate concentration) or standardized (>90% of patients received the same dialysate bicarbonate concentration). The standardized category was stratified by concentration: 35, 36 to 37, and ≥38 mmol/L. The primary outcome was the mean outpatient pre-dialysis serum bicarbonate concentration at the patient level. Methods We examined the association between dialysate bicarbonate category and pre-dialysis serum bicarbonate using an adjusted linear mixed model. Results All dialysate bicarbonate categories had a mean pre-dialysis serum bicarbonate concentration within the normal range. In the individualized category, 91% achieved a pre-dialysis serum bicarbonate ≥22 mmol/L, compared to 87% in the standardized category. Patients in the standardized category tended to have a serum bicarbonate that was 0.25 (95% confidence interval [CI] = -0.93, 0.43) mmol/L lower than patients in the individualized category. Relative to patients in the 35 mmol/L category, patients in the 36 to 37 and ≥38 mmol/L categories tended to have a serum bicarbonate that was 0.70 (95% CI = -0.30, 1.70) mmol/L and 0.87 (95% CI = 0.14, 1.60) mmol/L higher, respectively. There was no effect modification by age, sex, or history of chronic lung disease. Limitations We could not directly confirm that all laboratory measurements were pre-dialysis. Data on prescribed dialysate bicarbonate concentrations for individual dialysis sessions were not available, which may have led to some misclassification, and adherence to a practice of individualization could not be measured. Residual confounding is possible. Conclusions We found no significant difference in the pre-dialysis serum bicarbonate concentration irrespective of whether an individualized or standardized dialysate bicarbonate was used. Dialysate bicarbonate concentrations ≥38 mmol/L (vs 35 mmol/L) may increase the pre-dialysis serum bicarbonate concentration by 0.9 mmol/L.
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Affiliation(s)
- Amber O. Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University/Hamilton Health Sciences, ON, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Lauren Killin
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Sarah Bota
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Stephanie N. Dixon
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Amit X. Garg
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology, Western University, London, ON, Canada
| | - Claire Harris
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Stephanie Thompson
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Canada
| | - Peter G. Blake
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Clara Bohm
- Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer MacRae
- Division of Nephrology, Department of Medicine, University of Calgary, AB, Canada
| | - Samuel A. Silver
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
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Stuard S, Ridel C, Cioffi M, Trost-Rupnik A, Gurevich K, Bojic M, Karibayev Y, Mohebbi N, Marcinkowski W, Kupres V, Maslovaric J, Antebi A, Ponce P, Nada M, Salvador MEB, Rosenberger J, Jirka T, Enden K, Novakivskyy V, Voiculescu D, Pachmann M, Arkossy O. Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance. J Clin Med 2024; 13:3211. [PMID: 38892922 PMCID: PMC11173331 DOI: 10.3390/jcm13113211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90-120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.
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Affiliation(s)
- Stefano Stuard
- FME Global Medical Office, 61352 Bad Homburg, Germany; (M.P.); (O.A.)
| | | | | | | | | | - Marija Bojic
- FME Global Medical Office, 75400 Zvornik, Bosnia and Herzegovina;
| | | | | | | | | | | | - Alon Antebi
- FME Global Medical Office, Ra’anana 4366411, Israel;
| | - Pedro Ponce
- FME Global Medical Office, 1750-233 Lisboa, Portugal;
| | - Mamdouh Nada
- FME Global Medical Office, Riyadh 12472, Saudi Arabia;
| | | | | | - Tomas Jirka
- FME Global Medical Office, 16000 Praha, Czech Republic;
| | - Kira Enden
- FME Global Medical Office, 00380 Helsinki, Finland;
| | | | | | - Martin Pachmann
- FME Global Medical Office, 61352 Bad Homburg, Germany; (M.P.); (O.A.)
| | - Otto Arkossy
- FME Global Medical Office, 61352 Bad Homburg, Germany; (M.P.); (O.A.)
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Wieliczko M, Twardowska-Kawalec M, Debowska M, Pietribiasi M, Bialonczyk U, Waniewski J, Leypoldt JK, Matuszkiewicz-Rowinska J, Malyszko J. Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments. Sci Rep 2024; 14:2321. [PMID: 38281975 PMCID: PMC10822843 DOI: 10.1038/s41598-024-52757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
Recent studies have suggested benefits for time-dependent dialysate bicarbonate concentrations (Dbic) during hemodialysis (HD). In this clinical trial, we compared for the first time in the same HD patients the effects of time-dependent changes with constant Dbic on acid-base and uremic solute kinetics. Blood acid-base and uremic solute concentration were measured in twenty chronic HD patients during 4-h treatments with A) constant Dbic of 35 mmol/L; B) Dbic of 35 mmol/L then 30 mmol/L; and C) Dbic of 30 mmol/L then 35 mmol/L (change of Dbic after two hours during Treatments B and C). Arterial blood samples were obtained predialysis, every hour during HD and one hour after HD, during second and third treatments of the week with each Dbic concentration profile. Blood bicarbonate concentration (blood [HCO3]) during Treatment C was lower only during the first three HD hours than in Treatment A. Overall blood [HCO3] was reduced during Treatment B in comparison to Treatment A at each time points. We conclude that a single change Dbic in the middle of HD can alter the rate of change in blood [HCO3] and pH during HD; time-dependent Dbic had no influence on uremic solute kinetics.
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Affiliation(s)
- Monika Wieliczko
- The Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland.
| | | | - Malgorzata Debowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Urszula Bialonczyk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - John K Leypoldt
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | | | - Jolanta Malyszko
- The Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland
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Pun PH, Santacatterina M, Ways J, Redd C, Al-Khatib SM, Smyth-Melsky J, Chinitz L, Charytan DM. Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial. Kidney Int Rep 2023; 8:2385-2394. [PMID: 38025214 PMCID: PMC10658265 DOI: 10.1016/j.ekir.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Excessive dialytic potassium (K) and acid removal are risk factors for arrhythmias; however, treatment-to-treatment dialysate modification is rarely performed. We conducted a multicenter, pilot randomized study to test the safety, feasibility, and efficacy of 4 point-of-care (POC) chemistry-guided protocols to adjust dialysate K and bicarbonate (HCO3) in outpatient hemodialysis (HD) clinics. Methods Participants received implantable cardiac loop monitors and crossed over to four 4-week periods with adjustment of dialysate K or HCO3 at each treatment according to pre-HD POC values: (i) K-removal minimization, (ii) K-removal maximization, (iii) Acidosis avoidance, and (iv) Alkalosis avoidance. The primary end point was percentage of treatments adhering to the intervention algorithm. Secondary endpoints included pre-HD K and HCO variability, adverse events, and rates of clinically significant arrhythmias (CSAs). Results Nineteen subjects were enrolled in the study. HD staff completed POC testing and correctly adjusted the dialysate in 604 of 708 (85%) of available HD treatments. There was 1 K ≤3, 29 HCO3 <20 and 2 HCO3 >32 mEq/l and no serious adverse events related to study interventions. Although there were no significant differences between POC results and conventional laboratory measures drawn concurrently, intertreatment K and HCO3 variability was high. There were 45 CSA events; most were transient atrial fibrillation (AF), with numerically fewer events during the alkalosis avoidance period (8) and K-removal maximization period (3) compared to other intervention periods (17). There were no significant differences in CSA duration among interventions. Conclusion Algorithm-guided K/HCO3 adjustment based on POC testing is feasible. The variability of intertreatment K and HCO3 suggests that a POC-laboratory-guided algorithm could markedly alter dialysate-serum chemistry gradients. Definitive end point-powered trials should be considered.
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Affiliation(s)
- Patrick H. Pun
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michele Santacatterina
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Javaughn Ways
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sana M. Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jane Smyth-Melsky
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Larry Chinitz
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - David M. Charytan
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
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Leypoldt JK, Pietribiasi M, Debowska M, Wieliczko M, Twardowska-Kawalec M, Malyszko J, Waniewski J. Validity of the hydrogen ion mobilisation model during haemodialysis with time-dependent dialysate bicarbonate concentrations. Int J Artif Organs 2023; 46:507-513. [PMID: 37288535 DOI: 10.1177/03913988231179233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The hydrogen ion (H+) mobilisation model has been previously shown to accurately describe blood bicarbonate (HCO3) kinetics during haemodialysis (HD) when the dialysate bicarbonate concentration ([HCO3]) is constant throughout the treatment. This study evaluated the ability of the H+ mobilization model to describe blood HCO3 kinetics during HD treatments with a time-dependent dialysate [HCO3]. METHODS Data from a recent clinical study where blood [HCO3] was measured at the beginning of and every hour during 4-h treatments in 20 chronic, thrice-weekly HD patients with a constant (Treatment A), decreasing (Treatment B) and increasing (Treatment C) dialysate [HCO3] were evaluated. The H+ mobilization model was used to determine the model parameter (Hm) that provided the best fit of the model to the clinical data using nonlinear regression. A total of 114 HD treatments provided individual estimates of Hm. RESULTS Mean ± standard deviation estimates of Hm during Treatments A, B and C were 0.153 ± 0.069, 0.180 ± 0.109 and 0.205 ± 0.141 L/min (medians [interquartile ranges] were 0.145 [0.118,0.191], 0.159 [0.112,0.209], 0.169 [0.115,0.236] L/min), respectively; these estimates were not different from each other (p = 0.26). The sum of squared differences between the measured blood [HCO3] and that predicted by the model were not different during Treatments A, B and C (p = 0.50), suggesting a similar degree of model fit to the data. CONCLUSIONS This study supports the validity of the H+ mobilization model to describe intradialysis blood HCO3 kinetics during HD with a constant Hm value when using a time-dependent dialysate [HCO3].
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Affiliation(s)
- John Kenneth Leypoldt
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Poland
| | - Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Poland
| | - Malgorzata Debowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Poland
| | | | | | | | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Poland
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Wan J, Lin J, Wang W, Fu L, Zhang W, Liu J, Xiang Y, Chen J, He Y, Chen K. Relationship between Dialysate Bicarbonate Concentration and All-Cause Mortality in Hemodialysis Patients. Kidney Blood Press Res 2023; 48:460-467. [PMID: 37253349 DOI: 10.1159/000531267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION The optimal dialysate bicarbonate concentration (DBIC) for hemodialysis (HD) remains controversial. Herein, we analyzed the effect of dialysate bicarbonate levels on mortality in HD patients. METHODS Patients undergoing maintenance HD were recruited from the HD unit of the Daping Hospital. Patients were categorized into quartiles according to their DBIC level (quartile 1: <31.25 mmol/L, n = 77; quartile 2: 31.25-32.31 mmol/L, n = 76; quartile 3: 32.31-33.6 mmol/L; n = 81; quartile 4: ≥33.6 mmol/L, n = 79). Demographic and clinical data were collected. Survival curves were estimated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to estimate the association between DBIC and all-cause mortality. RESULTS We included 313 patients undergoing maintenance HD with a mean DBIC of 32.16 ± 1.59 mmol/L (range, 27.20-34.72 mmol/L). The patients in quartile 4 were more likely to have higher pre- and post-HD serum bicarbonate concentrations than those in other quartiles. The mortality rate was lowest in quartile 2 (10.53%). The survival time was significantly lower in the quartile 4 group than in the other quartiles (p = 0. 008, log-rank test). After full adjustment, the hazard ratio (per 3 mmol/L higher DBIC) for all-cause mortality was 4.29 (95% confidence interval, 2.11-8.47) in all patients, whereas no significant association was observed between DBIC and initial hospitalization. CONCLUSIONS Our data indicate that DBIC is positively associated with all-cause mortality. A DBIC concentration of 31-32 mmol/L may benefit patient outcomes. This study provides an evidence-based medical basis for optimal dialysis prescription in the future.
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Affiliation(s)
- Jingfang Wan
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Lin
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Weidong Wang
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Lili Fu
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Weiwei Zhang
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Liu
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Xiang
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jia Chen
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yani He
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Wound Trauma Medical Center, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
| | - Kehong Chen
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Wound Trauma Medical Center, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China
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Pietribiasi M, Waniewski J, Leypoldt JK. Mathematical modelling of bicarbonate supplementation and acid-base chemistry in kidney failure patients on hemodialysis. PLoS One 2023; 18:e0282104. [PMID: 36827348 PMCID: PMC9955675 DOI: 10.1371/journal.pone.0282104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Acid-base regulation by the kidneys is largely missing in end-stage renal disease patients undergoing hemodialysis (HD). Bicarbonate is added to the dialysis fluid during HD to replenish the buffers in the body and neutralize interdialytic acid accumulation. Predicting HD outcomes with mathematical models can help select the optimal patient-specific dialysate composition, but the kinetics of bicarbonate are difficult to quantify, because of the many factors involved in the regulation of the bicarbonate buffer in bodily fluids. We implemented a mathematical model of dissolved CO2 and bicarbonate transport that describes the changes in acid-base equilibrium induced by HD to assess the kinetics of bicarbonate, dissolved CO2, and other buffers not only in plasma but also in erythrocytes, interstitial fluid, and tissue cells; the model also includes respiratory control over the partial pressures of CO2 and oxygen. Clinical data were used to fit the model and identify missing parameters used in theoretical simulations. Our results demonstrate the feasibility of the model in describing the changes to acid-base homeostasis typical of HD, and highlight the importance of respiratory regulation during HD.
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Affiliation(s)
- Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
- * E-mail:
| | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - John K. Leypoldt
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
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Song HC, Shin J, Hwang JH, Kim SH. Utility of the Global Leadership Initiative on Malnutrition criteria for the nutritional assessment of patients with end-stage renal disease receiving chronic hemodialysis. J Hum Nutr Diet 2023; 36:97-107. [PMID: 35441765 DOI: 10.1111/jhn.13019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients on chronic haemodialysis. Thus, identifying accurate methods for diagnosing malnutrition is essential. The present retrospective study investigated the utility of the new Global Leadership Initiative on Malnutrition (GLIM) criteria in patients undergoing chronic haemodialysis. METHODS Phase angle and fat-free mass index (FFMI) were derived using bioelectrical impedance analysis. Malnutrition was determined when the subjects had at least one phenotypic criterion (weight loss, low body mass index [BMI] or FFMI). RESULTS This study included 103 patients undergoing chronic haemodialysis and 46 (44.7%) patients were diagnosed as malnourished. Malnutrition determined using the GLIM criteria was associated with increased risks of all-cause death (hazard ratio = 3.0, p = 0.044) and infection requiring hospitalisation (hazard ratio = 2.4, p = 0.015), independent of age, sex and comorbidities. However, malnutrition was not related to major adverse cardiovascular events (p = 0.908). We further evaluated the longitudinal changes in phenotypic parameters. Subjects with median levels of high-sensitivity C-reactive protein exceeding 5 mg L-1 exhibited decreased body weight and BMI (p = 0.015 and 0.016, respectively). In addition, body weight, BMI and FFMI were reduced in subjects with a median protein catabolic rate of < 1.0 mg kg-1 day-1 , even after adjustment for age, sex and comorbidities (p = 0.026, 0.053 and 0.039, respectively). CONCLUSIONS Malnutrition assessed using the GLIM criteria could be a useful predictor of mortality and infection in patients on chronic haemodialysis. To improve nutritional status, approaches for decreasing inflammation and increasing protein intake are needed.
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Affiliation(s)
- Hyun Chul Song
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
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Mudunuru SA, Navarrete J, O'Neill WC. Metabolic alkalosis in hemodialysis patients. Semin Dial 2023; 36:24-28. [PMID: 35384078 DOI: 10.1111/sdi.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemodialysis solutions typically contain a high alkali concentration designed to counter interdialytic acidosis, but this could result in persistent alkalosis in some patients. The prevalence and significance of persistent alkalosis were therefore examined at four outpatient centers over a 10-year period. METHODS Alkalosis was defined as a pre-dialysis serum [HCO3 ] ≥ 26 meq/L in >6 months of a 12-month period and was persistent if present in a majority of months thereafter. Control patients had a serum [HCO3 ] of 19-23 meq/L > 6 of every 12 months. Standard, citrate-containing dialysate was used in all patients without adjustment of bicarbonate concentration. RESULTS 444 of 1271 patients had alkalosis that persisted in 73. Compared to control patients, persistently alkalotic patients were older, but gender, race, starting weight, comorbidities, and mortality did not differ. Dialysis dose was 7% greater, protein catabolic rate was 11% lower, and interdialytic weight gain was 29% lower, all p < 0.001. Persistently alkalotic patients had double the incidence of cardiac arrhythmias (p = 0.07) and a 20% greater intradialytic blood pressure decrease (p < 0.001). CONCLUSIONS Alkalosis is common in hemodialysis patients and can be persistent, likely due to decreased protein catabolic rate and increased dialysis dose, and may have detrimental cardiovascular effects.
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Affiliation(s)
- S Arvind Mudunuru
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose Navarrete
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Abstract
Introduction Abnormalities in blood bicarbonates (HCO3–) concentration are a common finding in patients with chronic kidney disease, especially at the end-stage renal failure. Initiating of hemodialysis does not completely solve this problem. The recommendations only formulate the target concentration of ≥22 mmol/L before hemodialysis but do not guide how to achieve it. The aim of the study was to assess the acid–base balance in everyday practice, the effect of hemodialysis session and possible correlations with clinical and biochemical parameters in stable hemodialysis patients. Material and methods We enrolled 75 stable hemodialysis patients (mean age 65.5 years, 34 women), from a single Department of Nephrology. We assessed blood pressure, and acid–base balance parameters before and after mid-week hemodialysis session. Results We found significant differences in pH, HCO3– pCO2, lactate before and after HD session in whole group (p < 0.001; p < 0.001; p < 0.001; p = 0.001, respectively). Buffer bicarbonate concentration had only statistically significant effect on the bicarbonate concentration after dialysis (p < 0.001). Both pre-HD acid–base parameters and post-HD pH were independent from buffer bicarbonate content. We observed significant inverse correlations between change in the serum bicarbonates and only two parameters: pH and HCO3– before hemodialysis (p = 0.013; p < 0.001, respectively). Conclusions Despite the improvement in hemodialysis techniques, acid–base balance still remains a challenge. The individual selection of bicarbonate in bath, based on previous single tests, does not improve permanently the acid–base balance in the population of hemodialysis patients. New guidelines how to correct acid–base disorders in hemodialysis patients are needed to have less ‘acidotic’ patients before hemodialysis and less ‘alkalotic’ patients after the session.
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Affiliation(s)
- Monika Wieliczko
- Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland
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12
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Dialysis as a Novel Adjuvant Treatment for Malignant Cancers. Cancers (Basel) 2022; 14:cancers14205054. [PMID: 36291840 PMCID: PMC9600214 DOI: 10.3390/cancers14205054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary There is a clear need for new cancer therapies as many cancers have a very short long-term survival rate. For most advanced cancers, therapy resistance limits the benefit of any single-agent chemotherapy, radiotherapy, or immunotherapy. Cancer cells show a greater dependence on glucose and glutamine as fuel than healthy cells do. In this article, we propose using 4- to 8-h dialysis treatments to change the blood composition, i.e., lowering glucose and glutamine levels, and elevating ketone levels—thereby disrupting major metabolic pathways important for cancer cell survival. The dialysis’ impact on cancer cells include not only metabolic effects, but also redox balance, immunological, and epigenetic effects. These pleiotropic effects could potentially enhance the effectiveness of traditional cancer treatments, such as radiotherapies, chemotherapies, and immunotherapies—resulting in improved outcomes and longer survival rates for cancer patients. Abstract Cancer metabolism is characterized by an increased utilization of fermentable fuels, such as glucose and glutamine, which support cancer cell survival by increasing resistance to both oxidative stress and the inherent immune system in humans. Dialysis has the power to shift the patient from a state dependent on glucose and glutamine to a ketogenic condition (KC) combined with low glutamine levels—thereby forcing ATP production through the Krebs cycle. By the force of dialysis, the cancer cells will be deprived of their preferred fermentable fuels, disrupting major metabolic pathways important for the ability of the cancer cells to survive. Dialysis has the potential to reduce glucose levels below physiological levels, concurrently increase blood ketone body levels and reduce glutamine levels, which may further reinforce the impact of the KC. Importantly, ketones also induce epigenetic changes imposed by histone deacetylates (HDAC) activity (Class I and Class IIa) known to play an important role in cancer metabolism. Thus, dialysis could be an impactful and safe adjuvant treatment, sensitizing cancer cells to traditional cancer treatments (TCTs), potentially making these significantly more efficient.
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13
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Cuadrado E, Broseta JJ, Rodríguez-Espinosa D, Montagud-Marrahi E, Rodas L, Fontseré N, Arias-Guillén M, Rico N, Maduell F. Tailoring the dialysate bicarbonate eliminates pre-dialysis acidosis and post-dialysis alkalosis. Clin Kidney J 2022; 15:1946-1951. [PMID: 36158145 PMCID: PMC9494532 DOI: 10.1093/ckj/sfac128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Both metabolic acidosis and alkalosis increase hospitalizations, haemodynamic instability and mortality in haemodialysis patients. Unfortunately, current practices opt for a one-size-fits-all approach, leaving many patients either acidotic before or alkalotic after dialysis sessions. Therefore an individualized adjustment of these patients’ dialysate bicarbonate prescriptions could reduce these acid–base imbalances. Methods This is a prospective single-cohort study of patients on a chronic haemodiafiltration programme. The dialysate bicarbonate prescription was modified according to the pre- and post-dialysis total carbon dioxide (TCO2) values of 19–25 mEq/L and ≤29 mEq/L, respectively, with an adjustment formula calculated with the data obtained from previously published work by our group. In addition, we analysed this adjustment's effect on plasma sodium, potassium, phosphorus, parathyroid hormone (PTH) and calcium. Results At baseline, only 67.9% of patients were within the desired pre- and post-dialysis TCO2 target range. As of the first month, every followed patient met the TCO2 target range objective in pre-dialysis measurements and ˃95% met the post-dialysis TCO2 target. At the end of the study, 75% of the patients were on dialysate bicarbonate of 32–34 mEq/L. There were no clinically significant changes in calcium, phosphate, PTH, sodium or potassium levels. Also, we did not notice any increase in intradialytic adverse events. Conclusions We suggest an individualized adjustment of the dialysate bicarbonate concentration according to the pre- and post-dialysis TCO2 values. With it, nearly every patient in our cohort reached the established range, potentially reducing their mortality risk.
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Affiliation(s)
- Elena Cuadrado
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
| | - José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
| | | | | | - Lida Rodas
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
| | - Néstor Fontseré
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
| | - Marta Arias-Guillén
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
| | - Naira Rico
- Department of Biochemistry, Hospital Clínic of Barcelona, Spain
| | - Francisco Maduell
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Spain
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14
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Bock L, Keil A, Flury S, Kistler AD. Treatment of Metabolic Acidosis in Hemodialysis Patients Is Biased by Type of Vascular Access. Kidney Int Rep 2022; 7:1694-1698. [PMID: 35812293 PMCID: PMC9263232 DOI: 10.1016/j.ekir.2022.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
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15
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Dialysis Disequilibrium: Is Acidosis More Important than Urea? Case Rep Nephrol 2022; 2022:4964033. [PMID: 35242392 PMCID: PMC8888092 DOI: 10.1155/2022/4964033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Dialysis disequilibrium syndrome is a severe complication associated with dialysis treatment. Manifestations may range from mild such as headache to severe such as seizures and coma. Risk factors for development include initial dialysis treatment, uraemia, metabolic acidosis, and extremes of age. We report a case of dialysis disequilibrium in a patient with a failing kidney transplant secondary to the recurrence of IgA nephropathy. Disturbance in cognition and neurologic functioning occurred six hours after the completion of initiation of intermittent haemodialysis. During two sessions of intermittent haemodialysis of 3 and 4 hours, urea was reduced by 21.9 and 17.2 mmol/L and measured serum osmolality was reduced by 25 and 14 mOsm/kg, respectively. Subsequent admission to the intensive care unit and initiation of continuous renal replacement therapy for 48 hours resulted in complete resolution of symptoms. In this case report, we discuss atypical clinical and radiologic features of dialysis disequilibrium occurring with modest reductions in urea and serum osmolality.
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16
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Abreu ALCS, Soeiro EMD, Bedram LG, de Andrade MC, Lopes R. Brazilian guidelines for chronic kidney disease-mineral and bone metabolism disorders in children and adolescents. J Bras Nefrol 2021; 43:680-692. [PMID: 34910806 PMCID: PMC8823923 DOI: 10.1590/2175-8239-jbn-2021-s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Emília Maria Dantas Soeiro
- Universidade Federal de Pernambuco, Recife, PE, Brazil
- Instituto de Medicina Integral Professor Fernando Figueira - IMIP,
Recife, PE, Brazil
| | | | | | - Renata Lopes
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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17
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Wavhale RD, Dhobale KD, Rahane CS, Chate GP, Tawade BV, Patil YN, Gawade SS, Banerjee SS. Water-powered self-propelled magnetic nanobot for rapid and highly efficient capture of circulating tumor cells. Commun Chem 2021; 4:159. [PMID: 36697678 PMCID: PMC9814645 DOI: 10.1038/s42004-021-00598-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/01/2021] [Indexed: 01/28/2023] Open
Abstract
Nanosized robots with self-propelling and navigating capabilities have become an exciting field of research, attributable to their autonomous motion and specific biomolecular interaction ability for bio-analysis and diagnosis. Here, we report magnesium (Mg)-Fe3O4-based Magneto-Fluorescent Nanorobot ("MFN") that can self-propel in blood without any other additives and can selectively and rapidly isolate cancer cells. The nanobots viz; Mg-Fe3O4-GSH-G4-Cy5-Tf and Mg-Fe3O4-GSH-G4-Cy5-Ab have been designed and synthesized by simple surface modifications and conjugation chemistry to assemble multiple components viz; (i) EpCAM antibody/transferrin, (ii) cyanine 5 NHS (Cy5) dye, (iii) fourth generation (G4) dendrimers for multiple conjugation and (iv) glutathione (GSH) by chemical conjugation onto one side of Mg nanoparticle. The nanobots propelled efficiently not only in simulated biological media, but also in blood samples. With continuous motion upon exposure to water and the presence of Fe3O4 shell on Mg nanoparticle for magnetic guidance, the nanobot offers major improvements in sensitivity, efficiency and speed by greatly enhancing capture of cancer cells. The nanobots showed excellent cancer cell capture efficiency of almost 100% both in serum and whole blood, especially with MCF7 breast cancer cells.
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Affiliation(s)
- Ravindra D. Wavhale
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Kshama D. Dhobale
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Chinmay S. Rahane
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Govind P. Chate
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Bhausaheb V. Tawade
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Yuvraj N. Patil
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Sandesh S. Gawade
- Department of Surgery, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
| | - Shashwat S. Banerjee
- Central Research Laboratory, Maharashtra Institute of Medical Education and Research, Talegaon Dabhade, Pune, 410507 India
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20
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Oberbauer R, Meyer TW. Precision medicine in transplantation and hemodialysis. Nephrol Dial Transplant 2021; 36:31-36. [PMID: 34153984 PMCID: PMC8216726 DOI: 10.1093/ndt/gfaa367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
In kidney transplantation, precision medicine has already entered clinical practice. Donor and recipient human leucocyte antigen (HLA) regions are genotyped in two class 1 and usually three class 2 loci, and the individual degree of sensitization against alloimmune antigens is evaluated by the detection of anti-HLA donor-specific antibodies. Recently, the contribution of non-HLA mismatches to outcomes such as acute T- and B-cell-mediated rejection and even long-term graft survival was described. Tracking of specific alloimmune T- and B-cell clones by next generation sequencing and refinement of the immunogenicity of allo-epitopes specifically in the interaction with HLA and T- and B-cell receptors may further support individualized therapy. Although the choices of maintenance immunosuppression are rather limited, individualization can be accomplished by adjustment of dosing based on these risk predictors. Finally, supplementing histopathology by a transcriptomics analysis allows for a biological interpretation of the histological findings and avoids interobserver variability of results. In contrast to transplantation, the prescription of hemodialysis therapy is far from precise. Guidelines do not consider modifications by age, diet or many comorbid conditions. Patients with residual kidney function routinely receive the same treatment as those without. A major barrier hitherto is the definition of 'adequate' treatment based on urea removal. Kt/Vurea and related parameters neither reflect the severity of uremic symptoms nor predict long-term outcomes. Urea is poorly representative for numerous other compounds that accumulate in the body when the kidneys fail, yet clinicians prescribe treatment based on its measurement. Modern technology has provided the means to identify other solutes responsible for specific features of uremic illness and their measurement will be a necessary step in moving beyond the standardized prescription of hemodialysis.
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Affiliation(s)
- Rainer Oberbauer
- Klinische Abteilung für Nephrologie und Dialyse, Medical University of
Vienna, Vienna, Austria
| | - Timothy W Meyer
- Department of Medicine, VA Palo Alto HCS and Stanford University,
Palo Alto, CA, USA
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21
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Balboni F, Terreni A, Gallo M, Guzzi F, Caparrini C, Burbui S, Vezzosi M, Galora S, Lori G, Lippi G. Analytical evaluation of direct bicarbonate measurement with the new gem premier chemstat in hemodialysis patients. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:418-421. [PMID: 34057879 DOI: 10.1080/00365513.2021.1930142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
GEM Premier ChemSTAT is a whole-blood analyzer designed for providing a rapid basic metabolic panel, inclusive of creatinine and blood urea nitrogen, with the unique characteristic of providing measured bicarbonate (HCO3-) levels. The aim of this work was to evaluate the clinical performance of HCO3- assessment with this analyser in a real-life hemodialysis setting. Imprecision was calculated at different HCO3- levels, along with assay comparison with Gem Premier 4000 analysers. GEM Premier ChemSTAT displayed an imprecision and a bias (in comparison to GEM Premier 4000) for HCO3- of 0.4% and 37.3% at 20.8 mmol/L, 1.2% and 25.6% at 16.4 mmol/L, and 2.1% and 11.6% at 11.5 mmol/L, respectively, using three levels of HCO3- quality control sample ChemSTAT System Evaluator. At direct comparison with the GEM Premier 4000 in the hemodialysis setting, Bland-Altman analysis of HCO3- levels evidenced a bias (µ) of -4.9 (95% CI, -5.2 to -4.7) mmol/L. Such difference was attenuated by recalculating the GEM ChemSTAT expected HCO3- values from pH and pCO2 using the Henderson Hasselbach equation, µ=-0.07 (95%CI, -0.19 to 0.05) mmol/L (p = .24). In conclusion, our results show a remarkable difference between the HCO3- values reported by GEM ChemSTAT or GEM 4000. New reference values for GEM ChemSTAT HCO3- shall hence be defined according to our findings. We suggest that further investigation and a re-evaluation of the reference range should be made before extending the clinical use of this device.
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Affiliation(s)
- Fiamma Balboni
- Laboratory Service Istituto Fiorentino di Cura e Assistenza IFCA, Firenze, Italy
| | | | - Marco Gallo
- UO Nefrologia e Dialisi Istituto Fiorentino di Cura e Assistenza, IFCA, Firenze, Italy
| | - Francesco Guzzi
- UO Nefrologia e Dialisi Istituto Fiorentino di Cura e Assistenza, IFCA, Firenze, Italy
| | - Chiara Caparrini
- UO Anestesia e Rianimazione Istituto Fiorentino di Cura e Assistenza, IFCA, Firenze, Italy
| | - Stefania Burbui
- Outpatients Service Istituto Fiorentino di Cura e Assistenza, IFCA, Firenze, Italy
| | - Marco Vezzosi
- Laboratory Service Istituto Fiorentino di Cura e Assistenza IFCA, Firenze, Italy
| | - Silvia Galora
- Laboratory Service Istituto Fiorentino di Cura e Assistenza IFCA, Firenze, Italy
| | - Giulia Lori
- Laboratory Service Istituto Fiorentino di Cura e Assistenza IFCA, Firenze, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Morooka H, Yamamoto J, Tanaka A, Inaguma D, Maruyama S. Relationship between mortality and use of sodium bicarbonate at the time of dialysis initiation: a prospective observational study. BMC Nephrol 2021; 22:118. [PMID: 33823813 PMCID: PMC8025509 DOI: 10.1186/s12882-021-02330-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background Patients with chronic kidney disease often experience metabolic acidosis. Whether oral sodium bicarbonate can reduce mortality in patients with metabolic acidosis has been debated for years. Hence, this study was conducted to evaluate the utility of sodium bicarbonate in patients who will undergo dialysis therapy. In this study, we investigated the effect of oral sodium bicarbonate therapy on mortality in patients with end-stage kidney disease (ESKD) initiated on dialysis therapy. Methods We conducted an observational study of patients when they started dialysis therapy. There were 17 centres participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. Data were available on patients’ sex, age, use of sodium bicarbonate, drug history, medical history, vital data, and laboratory data. We investigated whether patients on oral sodium bicarbonate for more than three months before dialysis initiation had a better prognosis than those without sodium bicarbonate therapy. The primary outcome was defined as all-cause mortality. Results The study included 1524 patients with chronic kidney disease who initiated dialysis between October 2011 and September 2013. Among them, 1030 were men and 492 women, with a mean age of 67.5 ± 13.1 years. Of these, 677 used sodium bicarbonate and 845 did not; 13.6% of the patients in the former group and 21.2% of those in the latter group died by March 2015 (p < 0.001). Even after adjusting for various factors, the use of sodium bicarbonate independently reduced mortality (p < 0.001). Conclusions The use of oral sodium bicarbonate at the time of dialysis initiation significantly reduced all-cause mortality in patients undergoing dialysis therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02330-0.
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Affiliation(s)
- Hikaru Morooka
- Division of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan
| | | | - Akihito Tanaka
- Division of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan.
| | - Daijo Inaguma
- Division of Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shoichi Maruyama
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Metabolic acidosis is fairly common in patients with chronic kidney disease (CKD). The prevalence of metabolic acidosis increases with worsening kidney function and is observed in ∼40% of those with stage 4 CKD. For the past 2 decades, clinical practice guidelines have suggested treatment of metabolic acidosis to counterbalance adverse effects of metabolic acidosis on bone and muscle. Studies in animal models of CKD also demonstrated that metabolic acidosis causes kidney fibrosis. During the past decade, results from observational studies identified associations between metabolic acidosis and adverse kidney outcomes, and results from interventional studies support the hypothesis that treating metabolic acidosis with sodium bicarbonate preserves kidney function. However, convincing data from large-scale, double-blinded, placebo-controlled, randomized trials have been lacking. This review discusses findings from recent interventional trials of alkali therapy in CKD and new findings linking metabolic acidosis with cardiovascular disease in adults and CKD progression in children. Finally, a novel agent that treats metabolic acidosis in patients with CKD by binding hydrochloric acid in the gastrointestinal tract is discussed.
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Affiliation(s)
- Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Kalani L Raphael
- Division of Nephrology & Hypertension, Department of Medicine, Oregon Health & Science University and Portland VA Medical Center, Portland, OR
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24
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Abstract
Metabolic alkalosis is an increase in blood pH to >7.45 due to a primary increase in serum bicarbonate (HCO3 -). Metabolic alkalosis results from alkali accumulation or acid loss, and it is associated with a secondary increase in carbon dioxide arterial pressure (PaCO2). Metabolic alkalosis is a common acid-base disorder, especially in critically ill patients. The pathogenesis of chronic metabolic alkalosis includes two derangements, generation of metabolic alkalosis via gain of alkali or loss of acid and maintenance of metabolic alkalosis by increased tubular HCO3 - reabsorption (failure of the kidneys to excrete excess alkali). Metabolic alkalosis is the most common acid-base disorder in hospitalized patients, particularly in the surgical critical care unit. Mortality increases as pH increases.
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Affiliation(s)
- Mohammad Tinawi
- Nephrology, Nephrology Specialists, P.C, Munster, USA
- Medicine, Indiana University School of Medicine Northwest, Gary, USA
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25
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Alkalemia and Hepatic Encephalopathy in a Chronic Dialysis Patient. Am J Med Sci 2020; 362:207-210. [PMID: 34092398 DOI: 10.1016/j.amjms.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
Hepatic encephalopathy (HE) includes cognitive, psychiatric and neuromotor abnormalities observed from brain dysfunction secondary to liver disease and/or porto-systemic shunting. HE can have a wide range of clinical manifestations ranging from trivial lack of awareness, decreased attention span, personality changes to confusion, seizures, coma, and death. The onset of HE in cirrhosis is a poor prognostic factor. While HE has a complex pathogenesis which is not completely understood, hyperammonemia plays an important role in neurotoxicity and brain dysfunction. Alkalemia facilitates the conversion of NH4+ to NH3, which is free to cross the blood-brain barrier exacerbating HE. Prompt recognition and correction of underlying risk factors is central to the management of HE.
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Sahathevan S, Khor BH, Ng HM, Abdul Gafor AH, Mat Daud ZA, Mafra D, Karupaiah T. Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review. Nutrients 2020; 12:E3147. [PMID: 33076282 PMCID: PMC7602515 DOI: 10.3390/nu12103147] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
Hemodialysis (HD) majorly represents the global treatment option for patients with chronic kidney disease stage 5, and, despite advances in dialysis technology, these patients face a high risk of morbidity and mortality from malnutrition. We aimed to provide a novel view that malnutrition susceptibility in the global HD community is either or both of iatrogenic and of non-iatrogenic origins. This categorization of malnutrition origin clearly describes the role of each factor in contributing to malnutrition. Low dialysis adequacy resulting in uremia and metabolic acidosis and dialysis membranes and techniques, which incur greater amino-acid losses, are identified modifiable iatrogenic factors of malnutrition. Dietary inadequacy as per suboptimal energy and protein intakes due to poor appetite status, low diet quality, high diet monotony index, and/or psychosocial and financial barriers are modifiable non-iatrogenic factors implicated in malnutrition in these patients. These factors should be included in a comprehensive nutritional assessment for malnutrition risk. Leveraging the point of origin of malnutrition in dialysis patients is crucial for healthcare practitioners to enable personalized patient care, as well as determine country-specific malnutrition treatment strategies.
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Affiliation(s)
- Sharmela Sahathevan
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Ban-Hock Khor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (B.-H.K.); (A.H.A.G.)
| | - Hi-Ming Ng
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University Lakeside Campus, No 1, Jalan Taylors, Subang Jaya 47500, Malaysia;
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (B.-H.K.); (A.H.A.G.)
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
| | - Denise Mafra
- Post Graduation Program in Medical Sciences and Post-Graduation Program in Cardiovascular Sciences, (UFF), Federal Fluminense University Niterói-Rio de Janeiro (RJ), Niterói-RJ 24033-900, Brazil;
| | - Tilakavati Karupaiah
- School of BioSciences, Faculty of Health & Medical Sciences, Taylor’s University Lakeside Campus, No 1, Jalan Taylors, Subang Jaya 47500, Malaysia
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Copur S, Sag AA, Afsar B, Rossignol P, Covic A, Kanbay M. Complications of metabolic acidosis and alkalinizing therapy in chronic kidney disease patients: a clinician-directed organ-specific primer. Int Urol Nephrol 2020; 52:2311-2320. [PMID: 32661618 DOI: 10.1007/s11255-020-02563-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease is prevalent, affecting more than one in ten adults. In this population, metabolic acidosis is considered a key underlying pathophysiological feature, tying together bone mineral disorders, sarcopenia, insulin resistance, vascular calcification, pro-inflammatory and pro-thrombotic states. This review aims to address the paucity of literature on alkalinizing agents, a promising treatment option that has known adverse effects.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, USA
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Patrick Rossignol
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Montagud-Marrahi E, Broseta J, Rodriguez-Espinosa D, Lidia R, Hermida-Lama E, Xipell M, Arias-Guillén M, Fontseré N, Vera M, Bedini JL, Rico N, Maduell F. Optimization of dialysate bicarbonate in patients treated with online haemodiafiltration. Clin Kidney J 2020; 14:1004-1013. [PMID: 34141409 PMCID: PMC8204783 DOI: 10.1093/ckj/sfaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
Background Metabolic acidosis is a common problem in haemodialysis patients, but acidosis overcorrection has been associated with higher mortality. There is no clear definition of the optimal serum bicarbonate target or dialysate bicarbonate. This study analysed the impact of reducing dialysate bicarbonate from 35 to 32 mEq/L on plasma bicarbonate levels in a cohort of patients treated with online haemodiafiltration (OL-HDF). Methods We performed a prospective cohort study with patients in a stable chronic OL-HDF programme for at least 12 months in the Hospital Clinic of Barcelona. We analysed pre- and post-dialysis total carbon dioxide(TCO2) before and after dialysate bicarbonate reduction from 35 to 32 mEq/L, as well as the number of patients with a pre- and post-dialysis TCO2 within 19–25 and ≤29 mEq/L, respectively, after the bicarbonate modification. Changes in serum sodium, potassium, calcium, phosphorous and parathyroid hormone (PTH) were also assessed. Results We included 84 patients with a 6-month follow-up. At 6 months, pre- and post-dialysis TCO2 significantly decreased (26.78 ± 1.26 at baseline to 23.69 ± 1.92 mEq/L and 31.91 ± 0.91 to 27.58 ± 1.36 mEq/L, respectively). The number of patients with a pre-dialysis TCO2 >25 mEq/L was significantly reduced from 80 (90.5%) to 17 (20.2%) and for post-dialysis TCO2 >29 mEq/L this number was reduced from 83 (98.8%) to 9 (10.7%). PTH significantly decreased from 226.09 (range 172–296) to 182.50 (125–239) pg/mL at 6 months (P < 0.05) and post-dialysis potassium decreased from 3.16 ± 0.30 to 2.95 ± 0.48 mEq/L at 6 months (P < 0.05). Sodium, pre-dialysis potassium, calcium and phosphorous did not change significantly. Conclusions Reducing dialysate bicarbonate concentration by 3 mEq/L significantly and safely decreased pre- and post-dialysis TCO2, avoiding acidosis overcorrection and improving secondary hyperparathyroidism control. An individualized bicarbonate prescription (a key factor in the adequate control of acidosis) according to pre-dialysis TCO2 is suggested based on these results.
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Affiliation(s)
| | - Jose Broseta
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Rodas Lidia
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Marc Xipell
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Nestor Fontseré
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Manel Vera
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Naira Rico
- Department of Biochemistry, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francisco Maduell
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
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Leypoldt JK, Pietribiasi M, Ebinger A, Kraus MA, Collins A, Waniewski J. Acid-base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H + mobilization model. Int J Artif Organs 2020; 43:645-652. [PMID: 32126870 DOI: 10.1177/0391398820906524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The H+ mobilization model has been recently reported to accurately describe intradialytic kinetics of plasma bicarbonate concentration; however, the ability of this model to predict changing bicarbonate kinetics after altering the hemodialysis treatment prescription is unclear. METHODS We considered the H+ mobilization model as a pseudo-one-compartment model and showed theoretically that it can be used to determine the acid generation (or production) rate for hemodialysis patients at steady state. It was then demonstrated how changes in predialytic, intradialytic, and immediate postdialytic plasma bicarbonate (or total carbon dioxide) concentrations can be calculated after altering the hemodialysis treatment prescription. RESULTS Example calculations showed that the H+ mobilization model when considered as a pseudo-one-compartment model predicted increases or decreases in plasma total carbon dioxide concentrations throughout the entire treatment when the dialysate bicarbonate concentration is increased or decreased, respectively, during conventional thrice weekly hemodialysis treatments. It was further shown that this model allowed prediction of the change in plasma total carbon dioxide concentration after transfer of patients from conventional thrice weekly to daily hemodialysis using both bicarbonate and lactate as dialysate buffer bases. CONCLUSION The H+ mobilization model can predict changes in plasma bicarbonate or total carbon dioxide concentration during hemodialysis after altering the hemodialysis treatment prescription.
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Affiliation(s)
- John K Leypoldt
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Ebinger
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michael A Kraus
- NxStage Medical, Inc. (Fresenius Medical Care), Lawrence, MA, USA
| | - Allan Collins
- NxStage Medical, Inc. (Fresenius Medical Care), Lawrence, MA, USA.,Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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Leypoldt JK, Kraus MA, Jaber BL, Weinhandl ED, Collins AJ. Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates. BMC Nephrol 2019; 20:252. [PMID: 31288787 PMCID: PMC6617706 DOI: 10.1186/s12882-019-1450-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background Observational studies of hemodialysis patients treated thrice weekly have shown that serum and dialysate potassium and bicarbonate concentrations are associated with patient outcomes. The effect of more frequent hemodialysis on serum potassium and bicarbonate concentrations has rarely been studied, especially for treatments at low dialysate flow rate. Methods These post-hoc analyses evaluated data from patients who transferred from in-center hemodialysis (HD) to daily HD at low dialysate flow rates during the FREEDOM Study. The primary outcomes were the change in predialysis serum potassium and bicarbonate concentrations after transfer from in-center HD (mean during the last 3 months) to daily HD (mean during the first 3 months). Results After transfer from in-center HD to daily HD (data from 345 patients, 51 ± 15 years of age, mean ± standard deviation), predialysis serum potassium decreased (P < 0.001) by approximately 0.4 mEq/L when dialysate potassium concentration during daily HD was 1 mEq/L; no change occurred when dialysate potassium concentration during daily HD was 2 mEq/L. After transfer from in-center HD to daily HD (data from 284 patients, 51 ± 15 years of age), predialysis serum bicarbonate concentration decreased (P = 0.0022) by 1.0 ± 3.3 mEq/L when dialysate lactate concentration was 40 mEq/L but increased (P < 0.001) by 2.5 ± 3.5 mEq/L when dialysate lactate concentration was 45 mEq/L. These relationships were dependent on serum potassium and bicarbonate concentrations during in-center HD. Conclusions Control of serum potassium and bicarbonate concentrations during daily HD at low dialysate flow rates is readily achievable; the choice of dialysate potassium and lactate concentration can be informed when transfer is from in-center HD to daily HD. Electronic supplementary material The online version of this article (10.1186/s12882-019-1450-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Eric D Weinhandl
- NxStage Medical, Lawrence, MA, USA.,Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN, USA
| | - Allan J Collins
- NxStage Medical, Lawrence, MA, USA.,Medical School, University of Minnesota, Minneapolis, MN, USA
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Dao M, Touam M, Joly D, Mercadal L. Nouveaux dialysats : quel acide dans le bain de dialyse ? Nephrol Ther 2019; 15 Suppl 1:S91-S97. [DOI: 10.1016/j.nephro.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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33
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Assa S, Kuipers J, Ettema E, Gaillard CAJM, Krijnen WP, Hummel YM, Voors AA, van Melle JP, Westerhuis R, Willemsen A, Slart RHJA, Franssen CFM. Effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and left ventricular function assessed with 13N-NH 3 positron emission tomography and echocardiography. Am J Physiol Renal Physiol 2017; 314:F445-F452. [PMID: 29117996 DOI: 10.1152/ajprenal.00368.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemodialysis is associated with a fall in myocardial perfusion and may induce regional left ventricular (LV) systolic dysfunction. The pathophysiology of this entity is incompletely understood, and the contribution of ultrafiltration and diffusive dialysis has not been studied. We investigated the effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and LV function. Eight patients (7 male, aged 55 ± 18 yr) underwent 60 min of isolated ultrafiltration and 60 min of isovolemic dialysis in randomized order. Myocardial perfusion was assessed by 13N-NH3 positron emission tomography before and at the end of treatment. LV systolic function was assessed by echocardiography. Regional LV systolic dysfunction was defined as an increase in wall motion score in ≥2 segments. Isolated ultrafiltration (ultrafiltration rate 13.6 ± 3.9 ml·kg-1·h-1) induced hypovolemia, whereas isovolemic dialysis did not (blood volume change -6.4 ± 2.2 vs. +1.3 ± 3.6%). Courses of blood pressure, heart rate, and tympanic temperature were comparable for both treatments. Global and regional myocardial perfusion did not change significantly during either isolated ultrafiltration or isovolemic dialysis and did not differ between treatments. LV ejection fraction and the wall motion score index did not change significantly during either treatment. Regional LV systolic dysfunction developed in one patient during isolated ultrafiltration and in three patients during isovolemic dialysis. In conclusion, global and regional myocardial perfusion was not compromised by 60 min of isolated ultrafiltration or isovolemic dialysis. Regional LV systolic dysfunction developed during isolated ultrafiltration and isovolemic dialysis, suggesting that, besides hypovolemia, dialysis-associated factors may be involved in the pathogenesis of hemodialysis-induced regional LV dysfunction.
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Affiliation(s)
- Solmaz Assa
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands.,Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | | | - Esmée Ettema
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Carlo A J M Gaillard
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen , Groningen , The Netherlands
| | - Yoran M Hummel
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | | | - Antoon Willemsen
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,University of Twente, Faculty of Science and Technology, Department of Biomedical Photonic Imaging , Enschede , The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
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Harford A, Gul A, Cumber S, Paine S, Schrader R, Trujillo N, Zager P. Low dialysate potassium concentration is associated with prolonged recovery time. Hemodial Int 2017; 21 Suppl 2:S27-S32. [DOI: 10.1111/hdi.12598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonia Harford
- University of New Mexico; Health Sciences Center, Division of Nephrology; Albuquerque New Mexico USA
| | - Ambreen Gul
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
| | - Serena Cumber
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
| | - Susan Paine
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
| | - Ronald Schrader
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
| | - Nicole Trujillo
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
| | - Philip Zager
- University of New Mexico; Health Sciences Center, Division of Nephrology; Albuquerque New Mexico USA
- Dialysis Clinic, Inc., Quality Management; Albuquerque New Mexico USA
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35
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Chen W, Abramowitz MK. Epidemiology of Acid-Base Derangements in CKD. Adv Chronic Kidney Dis 2017; 24:280-288. [PMID: 29031354 DOI: 10.1053/j.ackd.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 01/13/2023]
Abstract
Acid-base disorders are in patients with chronic kidney disease, with chronic metabolic acidosis receiving the most attention clinically in terms of diagnosis and treatment. A number of observational studies have reported on the prevalence of acid-base disorders in this patient population and their relationship with outcomes, mostly focusing on chronic metabolic acidosis. The majority have used serum bicarbonate alone to define acid-base status due to the lack of widely available data on other acid-base disorders. This review discusses the time course of acid-base alterations in CKD patients, their prevalence, and associations with CKD progression and mortality.
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