We use different concentrations of bicarbonate for each patient . How often should we check ABG (arterial blood gases)?
There is no guideline recommending use of arterial blood gas to adjust bicarbonate in hemodialysis patients. Serum carbondioxide, which is gererally reported with electrolyte panel, is used to guide management. NKF KDOQI (Guideline 15) suggests to keep total CO2 level >22 mmol/l (>22 meq/l). Guideline 16 recommends a frequency of testing of at least monthly for hemodialysis patients.
serum total CO2 is not enough. In hemodialysis patients mixed acidbase disorders are not so rare as commonly thought (see Yamamotho AJKD few months ago), hence Arterial blood gas analysis are needed. I agree that there are not guidelines. I check BGA every 2 - 3 weeks in the first months, then I feel 2-months checking in chronic patients allows to have the goal
We used used to check blood gas each 3 motnh and to keep as possible arterial pH at physiological levels by modulating bicarbonate concentration (conductivity) in dialysate. Beside this, we check at least each month serum bicarbonate before diialysis session.
Hi Guy. That is the point: pH.
Due to high percentage of mixed acid-base disorders in hemodialysis patients there is a weak correlation between pH and HCO3, In fact for any HCO3 value the amount of pCO2 is spread over a wide range.
This is new !
Therefore before adjusting HCO3 in dialysis bath we have to look at blood gas analysis instead of serum HCO3 alone.
Sure!
Let me know if you need other papers.
Thank you for the interest.
Marco
Hi, I've read a research paper about this one. It's about the varying dialysate bicarbonate concentrations in maintenance hemodialysis patients specifically about the effect of it on post-dialysis alkalosis. Based on the study arterial blood gas were checked before and after the dialysis during mid-week, and it is carried out to measure the pH and serum bicarbonate concentration. I have attached here the copy of the research paper.
Hi,
I have recently read an article related to blood gas analysis on hemodialysis patients. Mentioned in the article, bicarbonate administration via dialysate actually help in maintaining the acid-base balance. Based on the discussion, blood gas analysis seem to appear with great significance and so is done often--most especially because the extreme values (either very high or very low amount) of serum bicarbonate could possibly indicate adverse outcomes. However, recent studies do not suggest the occurrence of adverse consequences despite higher pre-dialysis serum bicarbonate. Up to date, there are still limited-to-no available prospective studies about the association of serum bicarbonate and adverse effects on dialysis patients. Cited hereafter is the link directing to the article.
Misra, M. (2016). Pro: Higher serum bicarbonate in dialysis patients is protective. Retrieved on August 05, 2022 from Article Pro: Higher serum bicarbonate in dialysis patients is protec...
May be you are interested in the following:
https://www.kidneymedicinejournal.org/article/S2590-0595(22)00145-5/fulltext
Hello,
Dialysate administration of bicarbonate aids in the maintenance of acid-base equilibrium. According to the discussion, blood gas analysis appears to be of significant importance and is performed frequently—especially because extreme values (either very high or very low quantity) of serum bicarbonate may suggest poor consequences. Despite greater pre-dialysis serum bicarbonate levels, subsequent investigations have found no evidence of deleterious effects. There are currently few to no accessible prospective studies on the relationship between serum bicarbonate and adverse effects in dialysis patients.
Noh US, Yi JH, Han SW, Kim HJ. Varying Dialysate Bicarbonate Concentrations in Maintenance Hemodialysis Patients Affect Post-dialysis Alkalosis but not Pre-dialysis Acidosis. Electrolyte Blood Press. 2007 Dec;5(2):95-101. doi: 10.5049/EBP.2007.5.2.95. Epub 2007 Dec 31. PMID: 24459507; PMCID: PMC3894521.
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