Document Detail

Nutritional effects of delivered bicarbonate dose in maintenance hemodialysis patients.
MedLine Citation:
PMID:  12874745     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Metabolic acidosis is common in patients with end-stage renal disease (ESRD). Studies suggest that correction of acidosis may improve nutritional status and patient outcomes. The purpose of this study was to examine the effects of increasing delivered bicarbonate dose from 35 mmol/L to 39 mmol/L with respect to nutrition-related outcomes in maintenance hemodialysis patients (MHD). DESIGN AND SETTING: This was a longitudinal, observational study conducted at 4 dialysis centers in western Massachusetts. Patients were followed for 6 months after change in bicarbonate dose protocol. PATIENTS: The study sample consisted of 248 patients who had been on MHD for at least 1 year on the standard bicarbonate dialysate of 35 mmol/L without oral bicarbonate supplements. MAIN OUTCOME MEASURES: Measures of interest included predialysis serum bicarbonate, albumin, hemoglobin, potassium, phosphorus, calcium, and parathyroid hormone (iPTH), as well as protein catabolic rate (nPCR). A subset of patients (n = 35) was examined for changes via Subjective Global Assessment (SGA). RESULTS: Serum bicarbonate improved significantly from baseline (21.7 +/- 2.8 mmol/L; mean +/- SD) at 3 months (23.3 +/- 3.3) and 6 months (23.1 +/- 3.3) (P <.0001). Phosphorus decreased from 6.0 +/- 2.0 mmol/L at baseline to 5.7 +/- 1.7 mmol/L (P =.02) at 6 months, although calcium, iPTH, and potassium remained relatively stable. Serum bicarbonate was inversely and significantly correlated with nPCR at baseline (r = -0.23; P <.05) and 3 months (r = -0.22; P <.05). The nPCR decreased significantly (P =.001) from baseline (0.99 +/- 0.26) at 6 months (0.93 +/- 0.23), whereas the serum albumin and SGA scores did not differ. CONCLUSION: Increasing delivered bicarbonate dose improves serum bicarbonate and may decrease catabolism. Further study is needed to confirm the potential nutritional benefits.
Debra Blair; Carol Bigelow; Stephen J Sweet
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation     Volume:  13     ISSN:  1532-8503     ISO Abbreviation:  J Ren Nutr     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-22     Completed Date:  2004-10-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9112938     Medline TA:  J Ren Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  205-11     Citation Subset:  IM    
Renal Dietitian, Fresenius Medical Care-Western Mass. Kidney Center, Springfield, MA 01103, USA.
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MeSH Terms
Acidosis / etiology,  prevention & control*
Aged, 80 and over
Bicarbonates / administration & dosage*,  blood
Dose-Response Relationship, Drug
Kidney Failure, Chronic / complications,  therapy*
Longitudinal Studies
Middle Aged
Phosphorus / metabolism
Protein-Energy Malnutrition / etiology,  prevention & control*
Proteins / metabolism
Renal Dialysis* / adverse effects,  methods
Reg. No./Substance:
0/Bicarbonates; 0/Proteins; 7723-14-0/Phosphorus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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