Acid generation and elimination processes were compared with total base (bicarbonate plus metabolizable anions) turnover in 18 anuric patients undergoing post-dilutional haemofiltration. The study was conducted during the second haemodialysis session of the week by means of a whole-body base balance technique. The results showed that the mean rates of base loss and base gain during dialysis did not differ (i.e. the dialysis base balance approximated to zero). The concurrent mean rate of intestinal base absorption was 66±26 mmol/2 days, as calculated from the whole-body balance of the various inorganic cation and anion differences in a metabolic steady state. This level of intestinal base absorption would be capable of neutralizing the 59±21 mmol of H+ ions/2 days that is contributed by sulphuric acid, which is the most important endogenous acid produced in anuric patients. In spite of the fact that intestinal base supply was adequate to neutralize endogenous acid production completely, our patients presented with pre-dialysis non-carbonic acidosis. The depression of plasma bicarbonate levels could not, however, be explained by increased concentrations of the anion gap and organic acids, which were within normal limits both before and after dialysis. We suggest as an alternative hypothesis that this pre-dialysis acidosis may represent an isotonic dilution acidosis that is induced by the ingestion of base-free tap water in order for plasma tonicity to be protected from the accumulation of impermeant dietary solutes, which takes place during the interdialysis period in anuric patients.
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Research Article|
September 04 2001
Acid production and base balance in patients on chronic haemodialysis
R. MIONI;
R. MIONI
*Division of Nephrology, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
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M. GROPUZZO;
M. GROPUZZO
*Division of Nephrology, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
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M. MESSA;
M. MESSA
*Division of Nephrology, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
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G. BOSCUTTI;
G. BOSCUTTI
*Division of Nephrology, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
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A. D'ANGELO;
A. D'ANGELO
†Chair and Division of Nephrology, Policlinico Universitario, via Giustiniani, 35128 Padua, Italy
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A. CRUCIATTI;
A. CRUCIATTI
‡Institute of Clinical Chemistry, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
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G. MIONI
*Division of Nephrology, Ospedale ‘Santa Maria della Misericordia’, 33100 Udine, Italy
Correspondence: Dr Giuseppe Mioni (e-mail mionigiuseppe@libero.it).
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Publisher: Portland Press Ltd
Received:
January 15 2001
Revision Received:
April 19 2001
Accepted:
May 31 2001
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 2001
2001
Clin Sci (Lond) (2001) 101 (4): 329–337.
Article history
Received:
January 15 2001
Revision Received:
April 19 2001
Accepted:
May 31 2001
Citation
R. MIONI, M. GROPUZZO, M. MESSA, G. BOSCUTTI, A. D'ANGELO, A. CRUCIATTI, G. MIONI; Acid production and base balance in patients on chronic haemodialysis. Clin Sci (Lond) 1 October 2001; 101 (4): 329–337. doi: https://doi.org/10.1042/cs1010329
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