A Study of Acid-Base Imbalance on Regular Hemodialysis Patients

Park, H C; Ahn, J K; Lee, C H; Kahng, K W; Kim, S M; Park, C H; Kang, C M

Abstract

To study the effect of metabolic acidosis, which is generally present on chronic hemodialysis patients, blood gas analysis of A-V fistula blood, chemical chemistry data, nutritional parameters, and illness outcome were correlated on 146 patients. The results: 1) 28 paired samples of A-V fistula blood pH (7.318+/-0.052) were different from femoral artery blood pH (7.332+/-0.048), but the two were closely correlated (p=0.000). The correlation on PO2and PCO2tests were also strong. 2) The average of A-V fistula blood gas studies were pH 7.282+/-0.061. 3) The values of A-V fistula blood pH were most closely related with serum CO(2)content, followed by PCO(2)BUN, PO(2)and phosphate and not with nutritional status, frequencies of hospital admission and Karnofsky score. 4) During the 18 months observation, 8 of 146 patients died of medical causes. The expired cases were low in serum albumin, old in age, long in dialysis interval. The mortality rate was not related with blood gas parameters. 5) The nutritional parameters were, although loose, worse in the group of serum CC4 content more than 20mEq/L. 6) After sodium bicarbonate 1.5-3.0gm/day by mouth, there were insignificant rise in pH and in nutritional parameters. The incidence of gastrointestinal symptoms, however, increased significantly. In conclusion, nutritionally better patients were scattered in the serum CO(2)content below 20mEq/L, and therefore, near normal acid-base stuatus may suggest poor nutritional status. However, in acidotic patients, treatment with alkali may improve nutritional state further.