The effect of oral sodium bicarbonate on the improvement of interdialytic acidosis and hyperkalemia in prevalent hemodialysis patients

Abstract

Background Uremic toxins closely fit the saw-toothed profile including electrolytes, such as potassium, which is statistically associated with peri-dialytic morbidity and mortality. Acidosis follows a similar inverse pattern, with the bicarbonate levels gradually falling during the inter-dialytic period, before rapid supplementation during dialysis. Observational studies of clinical outcomes support the view that acidosis is harmful, showing that, after adjustment for comorbidity, pre-dialysis bicarbonate levels (HCO3) below 22 mmol/l are associated with excess mortality. The aim of this work is to study the effect of oral sodium bicarbonate supplementation on improvement of interdialytic acidosis, and hyperkalemia in patients on regular hemodialysis (HD). Patients and methods This was a one-arm interventional study that was conducted on a group of 50 adult end-stage renal disease patients on regular HD 3 times weekly at least for 3 months. Results Our study population’s mean ages were 41.8 ± 10.5 years, with male predominance 58%. PH value before and after sodium bicarbonate supplementation was 7.29 ± 0.07 and 7.38 ± 0.05, respectively, with level change 0.09 ± 0.06, which was statistically significant. Bicarbonate levels before and after sodium bicarbonate supplementation were 18.0 ± 1.8 and 23.4 ± 2.1(mmol/l), respectively, with level change 5.4 ± 1.7 (mmol/l), which was statistically significant. Also, potassium level (K) before and after sodium bicarbonate supplementation was 5.4 ± 0.5 and 5.0 ± 0.4 (mmol/l) respectively with level change –0.4 ± 0.3 (mmol/l), which was statistically significant. Regarding interdialytic body weight before and after sodium bicarbonate supplementation was 75.6 ± 6.5 and 75.5 ± 6.7 (kg), respectively, its change was –0.1 ± 0.5 (kg), which was statistically nonsignificant. As regards systolic blood pressure before and after sodium bicarbonate supplementation was 123.8 ± 11.4 and 125.6 ± 14.3 (mmHg), respectively, its change was 1.8 ± 9.4 (mmHg), which was statistically nonsignificant. Diastolic blood pressure before and after sodium bicarbonate supplementation was 76.0 ± 7.6 and 77.0 ± 8.1 (mmHg), respectively, and its change was 1.0 ± 9.5 (mmHg), which was statistically nonsignificant. Conclusion Oral sodium bicarbonate supplementation is effective in correcting interdialytic metabolic acidosis (PH and bicarbonate level) and hyperkalemia in HD patients without causing any significant increase in interdialytic body weight or systolic-diastolic blood pressure.