Profiled delivery of bicarbonate during weekly cycle of hemodialysis

• Autorzy: Pietribiasi Mauro , Leypoldt John K. , Wieliczko Monika , Twardowska-Kawalec Malgorzata , Debowska Malgorzata , Malyszko Jolanta , Waniewski Jacek

Identyfikatory

DOI

10.1016/j.bbe.2024.10.002

• Języki publikacji: EN

Abstrakty

EN

Background: Delivery of bicarbonate during hemodialysis (HD) is aimed at correcting metabolic acidosis in end-stage renal disease patients. We tested modified prescriptions of bicarbonate concentration in dialysis fluid (C_{D, bic}), aimed to achieve an optimal pre-dialytic bicarbonate plasma concentration (C_P,bic). Methods: We used a mathematical model to prescribe individualized HD treatments consisting of 1) adjustment of C_D,bic to get the pre-dialytic C_P,bic in a prescribed range, 2) increase of bicarbonate load before the long interdialytic break, and 3) a single step of increase in C_D,bic after two hours. The outcomes were tested in 24 stable HD patients, monitored during a week of standard HD (Test Week) and a week of modified treatment (Intervention Week). Results: The response to the model-based prescription was different whether the average CD,bic during the Intervention Week was higher or lower than the constant value used for the Test Week. For patients with lower average C_D,bic during the Intervention Week, a significant fraction achieved the target (22 ≤ C_P,bic ≤ 24 mEq/L). In the group with higher average C_D,bic, the interventions were effective only in increasing post-dialytic C_P,bic. The simple step-increase profile was effective in linearizing the intradialytic increase in bicarbonate and decreasing the amount of time spent by patients at high plasma C_P,bic. Conclusions: The interventions were effective mostly in patients who needed to lower their pre-dialytic C_P,bic. The resistance of the system to increasing pre-dialytic C_P,bic in other patients might be caused by modifications of breathing or in hydrogen generation that were not accounted for by our model.

Słowa kluczowe

EN

acid base balance; clinical study; hemodialysis protocol; kidney disease; mathematical modeling

PL

równowaga kwasowo-zasadowa; badanie kliniczne; protokół hemodializy; choroba nerek; modelowanie matematyczne

• Wydawca: Nałęcz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences ; Elsevier
• Czasopismo: Biocybernetics and Biomedical Engineering
• Rocznik: 2024
• Tom: Vol. 44, no. 4
• Strony: 836--843
• Opis fizyczny: Bibliogr. 16 poz., tab., wykr.

Twórcy

autor

Pietribiasi Mauro

• Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland

autor

Leypoldt John K.

• Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland

autor

Wieliczko Monika

• Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland

autor

Twardowska-Kawalec Malgorzata

• Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland

autor

Debowska Malgorzata

• Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland

autor

Malyszko Jolanta

• Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland

autor

Waniewski Jacek

• Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland

Bibliografia

• [1] Wu DY, Shinaberger CS, Regidor DL, McAllister CJ, Kopple JD, Kalantar-Zadeh K. Association between serum bicarbonate and death in hemodialysis patients: is it better to be acidotic or alkalotic? Clin J Am Soc Nephrol 2006;1:70-8. https://doi. org/10.2215/CJN.00010505.
• [2] Bommer J, Locatelli F, Satayathum S, Keen ML, Goodkin DA, Saito A, et al. Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:661-71. https://doi.org/10.1053/J.AJKD.2004.06.008.
• [3] Vashistha T, Kalantar-Zadeh K, Molnar MZ, Torlén K, Mehrotra R. Dialysis modality and correction of uremic metabolic acidosis: Relationship with all-cause and cause-specific mortality. Clin J Am Soc Nephrol 2013;8:254-64. https://doi. org/10.2215/CJN.05780612/-/DCSUPPLEMENTAL.
• [4] Tentori F, Karaboyas A, Robinson BM, Morgenstern H, Zhang J, Sen A, et al. Association of Dialysate Bicarbonate Concentration With Mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2013;62:738-46. https://doi.org/10.1053/J.AJKD.2013.03.035.
• [5] Tovbin D, Sherman RA. Correcting Acidosis during Hemodialysis: Current Limitations and a Potential Solution. Semin Dial 2016;29:35-8. https://doi.org/10.1111/SDI.12454.
• [6] Wieliczko M, Twardowska-Kawalec M, Debowska M, Pietribiasi M, Bialonczyk U, Waniewski J, et al. Effect of time-dependent dialysate bicarbonate concentrations on acid-base and uremic solute kinetics during hemodialysis treatments. Sci Rep 2024;14. https://doi.org/10.1038/S41598-024-52757-2.
• [7] Marano M, Marano S, Gennari FJ. Beyond bicarbonate: complete acid-base assessment in patients receiving intermittent hemodialysis. Nephrol Dial Transplant 2017;32:528-33. https://doi.org/10.1093/NDT/GFW022.
• [8] Leypoldt JK, Pietribiasi M, Debowska M, Wieliczko M, Twardowska-Kawalec M, Malyszko J, et al. Evaluating hydrogen ion mobilization during hemodialysis using only predialysis and postdialysis blood bicarbonate concentrations. Int J Artif Organs 2024. https://doi.org/10.1177/03913988241268026/SUPPL_FILE/SJPDF-1-JAO-10.1177_03913988241268026.PDF.
• [9] Leypoldt JK, Pietribiasi M, Debowska M, Wieliczko M, Twardowska-Kawalec M, Malyszko J, et al. Validity of the hydrogen ion mobilisation model during haemodialysis with time-dependent dialysate bicarbonate concentrations. Https:// DoiOrg/101177/03913988231179233 2023;46:507-13. https://doi.org/10.1177/03913988231179233.
• [10] Sargent JA, Marano M, Marano S, Gennari FJ. Acid-base homeostasis during hemodialysis: New insights into the mystery of bicarbonate disappearance during treatment. Semin Dial 2018;31:468-78. https://doi.org/10.1111/SDI.12714.
• [11] Wolf MB. Mechanisms of Acid-Base Kinetics during Hemodialysis: A Mathematical-Model Study. ASAIO J 2021;67:1263-7. https://doi.org/10.1097/ MAT.0000000000001366.
• [12] Marano S, Marano M, John GF. A New Approach to Bicarbonate Addition during Hemodialysis: Testing Model Predictions in a Patient Cohort. IEEE Access 2022;10: 17473-83. https://doi.org/10.1109/ACCESS.2022.3147261.
• [13] Pietribiasi M, Waniewski J, Leypoldt JK. Mathematical modelling of bicarbonate supplementation and acid-base chemistry in kidney failure patients on hemodialysis. PLoS One 2023;18. https://doi.org/10.1371/JOURNAL.PONE.0282104.
• [14] Gennari FJ, Marano M, Marano S. Replenishing Alkali During Hemodialysis: Physiology-Based Approaches. Kidney Med 2022;4. https://doi.org/10.1016/J.XKME.2022.100523.
• [15] Rees SE, Andreassen S. Mathematical models of oxygen and carbon dioxide storage and transport: the acid-base chemistry of blood. Crit Rev Biomed Eng 2005;33: 209-64. https://doi.org/10.1615/CRITREVBIOMEDENG.V33.I3.10.
• [16] Andreassen S, Rees SE. Mathematical models of oxygen and carbon dioxide storage and transport: interstitial fluid and tissue stores and whole-body transport. Crit Rev Biomed Eng 2005;33:265-98. https://doi.org/10.1615/CRITREVBIOMEDENG.V33.I3.20.

Uwagi

Opracowanie rekordu ze środków MNiSW, umowa nr POPUL/SP/0154/2024/02 w ramach programu "Społeczna odpowiedzialność nauki II" - moduł: Popularyzacja nauki (2025).