We do not use bicarb profiling, but I would assume that there is a risk for hypertension. The actual benefits of bicarb profiling are not well documented. The little info you can get is based on small RCTs.
Hemodialysis monitors allow you to independently set [HCO3] and Na+ in dialysis bath, so by using HCO3 profiling you have not Na+ overload. If you ask monitor to increase [HCO3] then your monitor increases NaHCO3 from basic concentrate and reduces suction from acid concentrate to obtain Na+ concentration you setted. The final effect of increase [HCO3] is to delivery lower acid concentrate (K+, Ca++, Acetate, Glucose) than you expected
We don't use bicarbonate profile even if we use high bicarbonate concentrations for having serum bicarbonate values of 28-30 mmol/l at the end of sessions . Hypertension is very rare ; on the contrary hypokalemia may be present so we use 3 mmol / l in dialysate and sometime 4 mmol/l .
Is dialisate bicarbonate 35mmol/l safe for the patients with bicarbonate level of 15 to 20 ?
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