To dialyze or to alkalyze?

Abstract

One of the most important achievements of the recent
years is the spread of kidney replacement therapy
and initiation of bicarbonate dialysis solutions.
These solutions, unlike acetate ones, provide the
natural environment of hemodialysis and influence
the health of the patients. The adequacy of dialysis
depends on the state of nutrition — the greater is the
protein consumption, the better is dialysis but also
the greater is the production of the acids. About 65%
of patients develop metabolic acidosis in the period
between dialyses. These patients should take daily
2–4 g of sodium bicarbonate on dialysis-free days
and the dialyses should be performed with the lowest
possible sodium level. This treatment provides
adequate dialysis with full maintenance of proper
electrolytes and acid-base balance as well as reduction
of post-dialysis polydipsia.