Brady JP, Hasbargen JA
Correction of metabolic acidosis and its effect on nutrition
in hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1403 1996
Malnutrition is recognized as a major predictor of mortality in ESRD.
Its causes are many, but metabolic acidosis of uremia may contribute
by altering amino acid metabolism. Additionally, metabolic acidosis
may produce nausea and anorexia , contributing to the patients
inadequate intake.
This prospective study looks at the effects of correcting metabolic
acidosis on 2 nutritional parameters, serum albumin and total
lymphocyte count. 36 stable HD patient with metabolic acidosis (pre-HD
bicarb <= 18 mEq/l) were randomized to receive standard bicarb bath
(35mM) versus a bath containing 40 mM bicarb, with p.o.
supplementation (1 mEq/kg/d) as needed to achieve serum bicarb > 21.
At the end of the 16 week study, mean bicarb was 17.3 vs. 20.2 mEq/l
(p=0.01) but the nutritional parameters were not significantly
affected.
Comment: Despite some pts receiving p.o bicarb, the mean
bicarb of the treatment group did not reach the target of 21 mEq/l.
The study was randomized but not blinded. The mean serum albumin of
3.8 does not seem all that low, and I wonder if some of the pts in
either group had metabolic acidosis due to high protein intake;
studying a more clearly malnourished group might have been more
fruitful. Also, some measure of dietary intake, ideally by measuring
PCR, would have been helpful, as it is possible that correction of
acidosis might subtly improve intake, before a rise in serum albumin
becomes manifest. (James A. Sondheimer MD, Wayne State
University, Detroit, MI)
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Am Soc Nephrol
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