Nephrology Dialysis Transplantation, Vol 13, Issue 3 674-678, Copyright © 1998 by Oxford University Press
E Movilli, N Bossini, B Viola, C Camerini, G Cancarini, P Feller, A Strada and R Maiorca
Background: Malnutrition in haemodialysis (HD)
patients has been referred to underdialysis with low protein intake, and to
acidosis. However, the separate effects of underdialysis and acidosis on
nutrition have not been clearly demonstrated. To evaluate the role of the
dialysis dose and of metabolic acidosis on nutrition, we measured the
predialysis serum HCO3, pH, serum albumin, PCRn, Kt/V, and BMI in 81
uraemic patients on maintenance bicarbonate, HD for 93±80
months. Patients with chronic liver diseases, malignancies, and cachexia
were excluded. Results: Mean age was 59±17
years, Kt/V was 1.29±0.21, PCRn 1.06±0.22 g/kg/day,
serum albumin 4.07plusmn;0.28 g/dl, BMI 23±4
kg/m2, HCO3 21.1±1.9 mmol/l, pH
7.36±0.04. Serum albumin showed a significant direct correlation
with: PCRn (P=0.001), HCO3 (P=0.001), pH (P=0.002), but no correlation with
Kt/V and BMI. Serum HCO3 correlated inversely with PCRn (P=0.027). Multiple
regression analysis confirmed the significant role of serum bicarbonate and
age, but not of Kt/V, on serum albumin concentrations. The role of PCRn
appeared to be marginal compared to serum bicarbonate in determining serum
albumin levels. Dividing patients into two groups, serum albumin was
3.96±0.22 g/dl with HCO3 ⩽20 mmol/l and
4.18±0.31 g/dl in those with serum HCO3⩾23 mmol/l
(P=0.002). PCRn in the same groups was respectively 1.14±0.24
g/kg/day and 1.01±0.23 g/kg/day (P=0.03). Most importantly,
serum albumin levels did not appear to be affected by the dialysis dose,
with Kt/V ranging from 0.90 to 1.88. Conclusions: In
HD patients with adequate Kt/V, metabolic acidosis exerts a detrimental
effect on serum albumin concentrations partially independently of the
protein intake, as evaluated by PCRn. In the presence of moderate to severe
metabolic acidosis, PCRn does not reflect the real dietary protein intake
of the patients, probably as a result of increased catabolism of endogenous
proteins. For this reason PCRn should be considered with caution as an
estimate of the dietary protein intake in HD patients in the presence of
metabolic acidosis.
ORIGINAL ARTICLES
Evidence for an independent role of metabolic acidosis on nutritional status in haemodialysis patients
Division of Nephrology, Spedali Civili, P le Ospedale Civile 1, I-25123 Brescia, Italy; Corresponding author
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