Abstract
Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients. To assess the prevalence of metabolic acidosis in hemodialysis and search their association with nutritional status. A cross-sectional study was performed in hemodialysis patients at a single center. Nutritional status was assessed by anthropometric, biochemical and multifrequency bioelectrical impedance analysis. Metabolic acidosis was defined as serum bicarbonate (BIC) < 22 mEq/L and patients were divided into 3 groups according to BIC (< 15.15 to 21.9 and ≥ 22). The association between BIC and continuous variables was investigated using the Kruskal Wallis test. The linear correlation between BIC and the variables of the study was also tested. We studied 95 patients, 59% male, mean age 52.3 years. The prevalence of metabolic acidosis was 94.7%. BMI, interdialytic weight gain and PTH were significantly different among the 3 groups of BIC. The BIC was negatively correlated with urea, phosphorus and interdialytic weight gain. There was no significant correlation with albumin, phase angle and lean body mass index. The prevalence of metabolic acidosis was high in this population, and a lower BIC correlated with higher levels of urea, PTH, phosphorus, interdialytic weight gain and lower BMI. The evaluation of acid-basic status should be routinely implemented in dialysis patients by considering the negative effects of acidosis on the nutritional status, inflammation and bone disease.
Highlights
Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients
The protein-energy malnutrition contributes to morbidity and mortality in hemodialysis and it Metabolic acidosis and nutritional status has a multifactorial pathophysiology, which may result from the loss of nutrients during dialysis, increased protein catabolism and decreased protein synthesis; reduction of caloric and protein intake, reduction in peripheral insulin resistance that results in acceleration of muscle atrophy and metabolic acidosis.[2]
The study has a cross-sectional design, including patients over 18 years of age in dialysis for more than 3 months, which could be submitted to the direct measurement of weight and height, had no contraindication to performing multifrequency bioelectrical impedance analysis, who had an arteriovenous fistula as vascular access for dialysis and who signed the consent form to participate in the study
Summary
Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients. The BIC was negatively correlated with urea, phosphorus and interdialytic weight gain. Conclusion: The prevalence of metabolic acidosis was high in this population, and a lower BIC correlated with higher levels of urea, PTH, phosphorus, interdialytic weight gain and lower BMI. The protein-energy malnutrition contributes to morbidity and mortality in hemodialysis and it Metabolic acidosis and nutritional status has a multifactorial pathophysiology, which may result from the loss of nutrients during dialysis, increased protein catabolism and decreased protein synthesis; reduction of caloric and protein intake, reduction in peripheral insulin resistance that results in acceleration of muscle atrophy and metabolic acidosis.[2]. Studies with patients in dialysis in our population assessing the prevalence of metabolic acidosis, as well as its association with nutritional status are scarce, justifying this study Other consequences of metabolic acidosis involve the loss of bone mass due to a release of calcium phosphate from the bone into the circulation, that helps in buffering acidosis, and results in deterioration of hyperphosphatemia; faster progression of renal failure; multiple endocrine disorders such as hyperglycemia, hyperinsulinemia, hyperglucagonemia, GH and catecholamines elevation; increased levels of cytokines and B2-microglobulin; hypertriglyceridemia; hypotension; malaise and increased mortality.[5]
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