Kidney Week

Abstract: SA-PO1085

Bicarbonate Individualization in Patients on Maintenance Hemodialysis

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Safranek, Roman, Univerzita Karlova, Prague, Czechia

Roman Safranek, MD, PhD

• Moucka, Petr, Fakultni Nemocnice Hradec Kralove, Hradec Kralove, Hradec Králové Region, Czechia

Petr Moucka

• Reznickova, Alena, Univerzita Karlova, Prague, Czechia

Alena Reznickova, MD

Background

Bicarbonate is an important component of dialysis solution and its concentration affects metabolic functions. In fact, both metabolic alkalosis and acidosis increase the mortality risk. Individualization of bicarbonate concentration in dialysis solution is thus recommended. We tested simple method for bicarbonate individualization.

Methods

We included 103 patients (68 males) to a single-center study. Before initiation of the study, all patients were dialysed with 32 mmol/l bicarbonate dialysis solution (no citrate, 3 mmol/l acetate) and pre- and post-dialysis acid-base parameters were measured. For subsequent 7 weeks dialysis bicarbonate was set based on predialysis bicarbonate as shown in Table to target predialysis bicarbonate within normal range 22-26 mmol/l.

Results

Pre- and postdialysis bicarbonate levels were 20.2±2.3 mmol/l and 26.6±1.6 mmol/l at the beginning of the study, respectively. These values increased to 22.4±2.3 mmol/l predialysis and 29.6±2.2 mmol/l postdialysis after 7 weeks. At the beginning of the study predialysis bicarbonate was within normal range in 20 (19 %) of patients and increased to 50 patients (49 %) after 7 weeks. Use of bicarbonate dialysis concentration 38 and 40 mmol/l led to postdialysis alkalosis with bicarbonate higher than 30 mmol/l in 70 % of patients. We observed no clinically significant adverse effects of bicarbonate concentrations changes.

Conclusion

Individualization of bicarbonate concentrations in dialysis solution based on predialysis bicarbonate levels as shown in Table led to a significant increase in patients with target predialysis bicarbonate. This switch should be followed by fine titration during maintenance dialysis treatment. Targeting normal predialysis bicarbonate level in severely acidotic patients leads to postdialysis alkalosis; these patients may be considered for interdialytic bicarbonate administration.