I check VBG and change the bicarbonate concentration for hemodialysis patients . How often should i check VBG . and how often should i change the bicarbonate concentration in dialysate fluid ?
There are no evidences to change HCO3 in the bath (See Lisawat & Gennari Am J Kidney Dis. 2014 Jul;64(1):151-5 and related comments on).
However I suggest you to read the paper by Tentori (Am J Kidney Dis. 2013 Oct;62(4):738-46. doi: 10.1053/j.ajkd.2013.03.035 for free).
Do you want to know as I do ? I check Arterial blood gas analysis about monthly and I get off HCO3 in the bath (from 35 to 32) if patient has not low HCO3. (please note that 3 - 4 mmol of acetate are also in bath).
This topic is very interesting
you should correct bicarbonate in order to obtain a concentration of 28 - 30 mmol / l at the end of dialysis session . Hypercorrection is useful for having a good BE during post dialysis period . Infact acidosis condition does not consent a good metabolic equilibrium and then a possible malnutrition
Hi Ramin
please note that well functioning arterovenous fistula gives us pure arterial blood, so you can check Arterial rather than venous blood gasanalysis.
In doubtful cases you check SpO2 by pulseoximeter. If SpO2 is consistent with SO2 showed by blood gas analysis then blood analyzed is "arterial"
Dear Ennio
mixed (metabolic plus respiratory) post-dialysis alkalosis could increase mortality of hemodialysis patients via vascular calcification and sudden cardiac death. Hypercorrection could not be a good idea.
We control hypokaliemia , that is the principal cause of sudden cardiac dead , using 3 mmol /l K+ and 1.25 mmol/l Ca++ in dialysate . Vascular calcifications depend on many factors and alkalosis is not the main factor . My experience began many years ago and vascular calcifications are the minor problem with respect to malnutrition linked to prolonged acidosis .
How often we should check bicarbonate. Every month I suppose, if there is something wrong, even four weeks might be too long to react.
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