Correction of metabolic acidosis increases serum albumin concentrations and decreases kinetically evaluated protein intake in haemodialysis patients : A prospective study

• Published in: Nephrology, dialysis, transplantation Vol. 13; no. 7; pp. 1719 - 1722
• Main Authors: MOVILLI, E, ZANI, R, CARLI, O, SANGALLI, L, POLA, A, CAMERINI, C, CANCARINI, G. C, SCOLARI, F, FELLER, P, MAIORCA, R
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.1998
• Subjects: Acidosis - drug therapy; Acidosis - etiology; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bicarbonates - blood; Biological and medical sciences; Dietary Proteins - administration & dosage; Dietary Proteins - metabolism; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Hydrogen-Ion Concentration; Intensive care medicine; Male; Medical sciences; Middle Aged; Nutrition Disorders - drug therapy; Nutrition Disorders - etiology; Nutrition Disorders - metabolism; Nutritional Status; Prospective Studies; Proteins - metabolism; Renal Dialysis - adverse effects; Serum Albumin - metabolism; Sodium Bicarbonate - administration & dosage; Uremia - metabolism; Uremia - therapy; Kidney disease; Human; Urinary system disease; Hemodialysis; Albumin; Acid base balance disorder; Metabolism; Protein; Extrarenal dialysis; Metabolic disorder; Treatment; Renal failure; Complication; Serum; Catabolism; Uremia; Metabolic acidosis; Corrections; Nutritional status
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/13.7.1719

Metabolic acidosis in haemodialysis (HD) patients increases whole body protein degradation while the correction of acidosis reduces it. However, the effects of the correction of acidosis on nutrition have not been clearly demonstrated. In this study we have evaluated the effects of 3 months of correction of metabolic acidosis by oral sodium bicarbonate supplementation on protein catabolic rate (PCRn) and serum albumin concentrations in 12 uraemic patients on maintenance HD for at least 6 months (median 49 months; range 6-243 months). Pre-dialysis serum bicarbonate, arterial pH, serum albumin, total serum proteins, serum creatinine, plasma sodium, haemoglobin, PCRn, Kt/V, and TACurea, were evaluated before and after correction. Serum bicarbonate levels and arterial pH increased respectively from 19.3 +/- 0.6 mmol/l to 24.4 +/- 1.2 mmol/l (P < 0.0001) and 7.34 +/- 0.03 to 7.40 +/- 0.02 (P < 0.0001). Serum albumin increased from 34.9 +/- 2.1 g/l to 37.9 +/- 2.9 g/l (P < 0.01), while PCRn decreased from 1.11 +/- 0.17 g/kg/day to 1.03 +/- 0.17 g/kg/day (P < 0.001). No changes in Kt/V, total serum proteins, serum creatinine, plasma sodium, haemoglobin, body weight, pre dialysis systolic and diastolic blood pressure, and intradialytic weight loss were observed. Our data demonstrate that correction of metabolic acidosis improves serum albumin concentrations in HD patients. The correction of acidosis induces a decrease in PCRn values, as evaluated by kinetic criteria, suggesting that in the presence of moderate to severe acidosis this parameter does not reflect the real dietary protein intake of the patients probably as a result of increased catabolism of endogenous proteins. The correction of metabolic acidosis should be considered of paramount importance in HD patients.