Abstract: SA-PO924
Effect of Dialysate Lactate Concentration During Daily Hemodialysis (DHD) on Serum Bicarbonate (BIC) Concentration After Transfer from In-Center Hemodialysis (ICHD)
Session Information
- Dialysis: Home Hemodialysis
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Leypoldt, J. Ken, Unaffiliated, San Clemente, California, United States
- Kraus, Michael A., NxStage Medical, Inc, FISHERS, Indiana, United States
- Jaber, Bertrand L., St. Elizabeth's Medical Center, Boston, Massachusetts, United States
- Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
- Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background
Lactate is used as an alternative dialysate buffer to BIC during DHD, but the outcome of dialysate lactate concentration on acid-base balance is unclear. We examined the effect of the dialysate lactate concentration during DHD on serum BIC concentration after transfer from ICHD.
Methods
This post hoc analysis evaluated data from patients who transferred from ICHD to DHD during the FREEDOM Study (N=284). DHD was performed at low dialysate flow rates; treatment frequency per week and dialysate volume per session were 5.9±0.2 and 22.1±4.0 L, respectively. Dialysate lactate concentration during DHD was either 40 or 45 mM. Serum BIC was the average concentration from the last 3 months of ICHD or the first 3 months of DHD.
Results
Mean±SD serum BIC values are tabulated. Overall, a larger increase in serum BIC after transfer from ICHD to DHD was associated with higher dialysate lactate concentration during DHD (P<0.001) and lower serum BIC during ICHD (P<0.001), the latter is illustrated for dialysate lactate concentration of 45 mM in the figure.
Conclusion
Transfer from ICHD to DHD using lactate as the dialysate buffer may be accompanied by changes in serum BIC. This study provides guidance for choosing dialysate lactate concentrations for DHD at low dialysate flow rates.
| Dialysate BIC during ICHD (mM) | Dialysate Lactate during DHD (mM) | N | Serum BIC during ICHD (mM) | Serum BIC during DHD (mM) |
| ≤35 | 40 | 37 | 22.8±2.4 | 22.5±2.7 |
| 45 | 83 | 22.1±2.9 | 25.6±3.0* | |
| >35 & ≤38 | 40 | 33 | 23.7±3.1 | 23.2±2.4 |
| 45 | 41 | 23.8±2.9 | 24.8±2.5 | |
| >38 | 40 | 37 | 23.7±2.4 | 21.5±2.5* |
| 45 | 53 | 22.6±3.9 | 24.9±2.7* |
*Different from value during ICHD (P<0.001) by paired Student’s t-test.
Funding
- Commercial Support – NxStage Medical