Abstract
BACKGROUND: Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease on hemodialysis. Metabolic acidosis induces net negative nitrogen and total body protein balance. Some patients undergoing maintenance dialysis have low plasma bicarbonate levels due to inadequate dialysis. We aimed to evaluate the role of metabolic acidosis on serum albumin concentration in patients with end stage renal disease on hemodialysis, and to determine differences of serum bicarbonate level before and after hemodialysis in actual situation. 
 
 METHODS: This cross sectional comparative study was conducted in the Iraqi Center for Hemodialysis/ Baghdad Teaching Hospital from June to December 2015. It included 100 subjects with end stage renal disease on hemodialysis. They were divided equally into cases with low albumin and comparison group with normal albumin level. Serum bicarbonate and the Kt/V were measured for all subjects before, after, and before next hemodialysis session to show the adequacy of dialysis.
 
 RESULTS: There was a significant association between low bicarbonate and low albumin level in hemodialysis patient and between numbers and duration of dialysis session with albumin. Low Kt/V was significantly associated with hypoalbuminemia. There was no statistically significant association between age and gender with hypoalbuminemia.
 
 CONCLUSION: This study shows that patients with metabolic acidosis had a lower serum albumin concentration and there was a significant correlation between numbers, duration and adequacy of hemodialysis sessions and albumin level. We recommend to increase the numbers of dialysis centers in Iraq and adjust the bicarbonate doses in dialysate according to patient’s bicarbonate levels.
Highlights
Malnutrition affects 1/3 of hemodialysis (HD) patients and associates with a higher risk of morbidity and mortality
There was a significant association between low bicarbonate and low albumin level in hemodialysis patient and between numbers and duration of dialysis session with albumin
Low Kt/V was significantly associated with hypoalbuminemia
Summary
Malnutrition affects 1/3 of hemodialysis (HD) patients and associates with a higher risk of morbidity and mortality. Alb) is a marker of nutrition and inflammation, and hypoalbuminemia is the most powerful predictor of death in patients with ESRD (Yashpal & Kher, 2012). One of the most powerful regulators of albumin synthesis is availability of dietary protein. Protein calorie malnutrition is clearly a potential cause of reduced albumin synthesis, decreased plasma albumin levels and increased morbidity and mortality in the chronically ill population (Gama-Axelsson et al, 2012). Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease on hemodialysis. We aimed to evaluate the role of metabolic acidosis on serum albumin concentration in patients with end stage renal disease on hemodialysis, and to determine differences of serum bicarbonate level before and after hemodialysis in actual situation
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