Are Target Serum Bicarbonate Levels Achieved in Maintenance Hemodialysis Patients: A Single Centre Experience

Abstract

Majority of the maintenance hemodialysis patients donot achieve the target predialysisserum bicarbonate levels. Routine monitoring of serum bicarbonate in diaysis patients is not universally done.We aimed to assess whether our dialysis population attained the predialysis serum bicarbonate target of >22 mEq/L as recommended by the NKF-KDOQI. Correlation between predialysis bicarbonate and clinical and biochemical parameters was also assessed. Fifty patients undergoing maintenance hemodialysis in Government Medical College, Thiruvananthapuram were included in the study.All patients received fixed non-individualizeddialysate bicarbonate concentrations. The mean predialysis bicarbonate obtained was 19 ± 4.2 mEq/L. Thirty six patients(72%) had bicarbonate levels less than 22 mEq/L. Nineteen patients (38%) had bicarbonate level less than 17mEq/L and 5 patients (10%) had level greater than 25 mEq/L. Majority of the patients failed to achieve the target serum bicarbonate. A negative correlation was obtained for predialysis bicarbonate levels with BMI, total protein, serum uric acid, serum phosphorus and serum ferritin. Better nutritional status may be associated with reduction in bicarbonate level because of increased acid generation. In conclusion this study emphasizes the importance of regular monitoring of serum bicarbonate levels in our dialysis patients and the need for adjusting the dialysate bicarbonate concentrations accordingly.