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Roh YI, Kim HI, Kim SJ, Cha KC, Jung WJ, Park YJ, Hwang SO. End-tidal carbon dioxide after sodium bicarbonate infusion during mechanical ventilation or ongoing cardiopulmonary resuscitation. Am J Emerg Med 2024; 76:211-216. [PMID: 38096770 DOI: 10.1016/j.ajem.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE End-tidal CO2 is used to monitor the ventilation status or hemodynamic efficacy during mechanical ventilation or cardiopulmonary resuscitation (CPR), and it may be affected by various factors including sodium bicarbonate administration. This study investigated changes in end-tidal CO2 after sodium bicarbonate administration. MATERIALS AND METHODS This single-center, prospective observational study included adult patients who received sodium bicarbonate during mechanical ventilation or CPR. End-tidal CO2 elevation was defined as an increase of ≥20% from the baseline end-tidal CO2 value. The time to initial increase (lag time, Tlag), time to peak (Tpeak), and duration of the end-tidal CO2 rise (Tduration) were compared between the patients with spontaneous circulation (SC group) and those with ongoing resuscitation (CPR group). RESULTS Thirty-three patients, (SC group, n = 25; CPR group, n = 8), were included. Compared with the baseline value, the median values of peak end-tidal CO2 after sodium bicarbonate injection increased by 100% (from 21 to 41 mmHg) in all patients, 89.5% (from 21 to 39 mmHg) in the SC group, and 160.2% (from 15 to 41 mmHg) in the CPR group. The median Tlag was 17 s (IQR: 12-21) and the median Tpeak was 35 s (IQR: 27-52). The median Tduration was 420 s (IQR: 90-639). The median Tlag, Tpeak, and Tduration were not significantly different between the groups. Tduration was associated with the amount of sodium bicarbonate for SC group (correlation coefficient: 0.531, p = 0.006). CONCLUSION The administration of sodium bicarbonate may lead to a substantial increase in end-tidal CO2 for several minutes in patients with spontaneous circulation and in patients with ongoing CPR. After intravenous administration of sodium bicarbonate, the use of end-tidal CO2 pressure as a physiological indicator may be limited.
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Affiliation(s)
- Young-Il Roh
- Department of Emergency Medicine, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea; Research Institute of Resuscitation Science, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea
| | - Hyung Il Kim
- Department of Emergency Medicine, Dankook University, Republic of Korea
| | - Sun Ju Kim
- Department of Emergency Medicine, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea; Research Institute of Resuscitation Science, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea; Research Institute of Resuscitation Science, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea
| | - Yeon Jae Park
- Department of Biostatistics, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea; Research Institute of Resuscitation Science, Wonju College of Medicine Yonsei University, Wonju, Republic of Korea.
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Anagnostopoulos V, Katsenovich Y, Lee B, Lee HM. Biotic dissolution of autunite under anaerobic conditions: effect of bicarbonates and Shewanella oneidensis MR1 microbial activity. Environ Geochem Health 2020; 42:2547-2556. [PMID: 31858357 DOI: 10.1007/s10653-019-00480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Uranium is a contaminant of major concern across the US Department of Energy complex that served a leading role in nuclear weapon fabrication for half a century. In an effort to decrease the concentration of soluble uranium, tripolyphosphate injections were identified as a feasible remediation strategy for sequestering uranium in situ in contaminated groundwater at the Hanford Site. The introduction of sodium tripolyphosphate into uranium-bearing porous media results in the formation of uranyl phosphate minerals (autunite) of general formula {X1-2[(UO2)(PO4)]2-1·nH2O}, where X is a monovalent or divalent cation. The stability of the uranyl phosphate minerals is a critical factor that determines the long-term effectiveness of this remediation strategy that can be affected by biogeochemical factors such as the presence of bicarbonates and bacterial activity. The objective of this research was to investigate the effect of bicarbonate ions present in the aqueous phase on Ca-autunite dissolution under anaerobic conditions, as well as the role of metal-reducing facultative bacterium Shewanella oneidensis MR1. The concentration of total uranium determined in the aqueous phase was in direct correlation to the concentration of bicarbonate present in the solution, and the release of Ca, U and P into the aqueous phase was non-stoichiometric. Experiments revealed the absence of an extensive biofilm on autunite surface, while thermodynamic modeling predicted the presence of secondary minerals, which were identified through microscopy. In conclusion, the dissolution of autunite under the conditions studied is susceptible to bicarbonate concentration, as well as microbial presence.
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Affiliation(s)
| | - Yelena Katsenovich
- Applied Research Center, Florida International University, 10555 W Flagler Str, Miami, FL, 33174, USA
| | - Brady Lee
- Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Hope M Lee
- Savannah River National Laboratory, 3100 George Washington Way, Richland, WA, 99352, USA
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Mohanakrishna G, Abu Reesh IM, Vanbroekhoven K, Pant D. Microbial electrosynthesis feasibility evaluation at high bicarbonate concentrations with enriched homoacetogenic biocathode. Sci Total Environ 2020; 715:137003. [PMID: 32023516 DOI: 10.1016/j.scitotenv.2020.137003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
An enrichment methodology was developed for a homoacetogenic biocathode that is able to function at high concentrations of bicarbonates for the microbial electrosynthesis (MES) of acetate from carbon dioxide. The study was performed in two stages; enrichment of consortia in serum bottles and the development of a biocathode in MES. A homoacetogenic consortium was sequentially grown under increasing concentrations of bicarbonate, in serum bottles, at room temperature. The acetate production rate was found to increase with the increase in the bicarbonate concentration and evidenced a maximum production rate of 260 mg/L d-1 (15 g HCO3-/L). On the contrary, carbon conversion efficiency decreased with the increase in the bicarbonate concentration, which evidenced a maximum at 2.5 g HCO3-/L (90.16%). Following a further increase in the bicarbonate concentration up to 20 g HCO3-/L, a visible inhibition was registered with respect to the acetate production rate and the carbon conversion efficiency. Well adapted biomass from 15 g HCO3-/L was used to develop biocathodic catalyst for MES. An effective biocathode was developed after 4 cycles of operation, during which acetate production was improved gradually, evidencing a maximum production rate of 24.53 mg acetate L-1 d-1 (carbon conversion efficiency, 47.72%). Compared to the enrichment stage, the carbon conversion efficiency and the rate of acetate production in MES were found to be low. The production of acetate induced a change in the catholyte pH, from neutral conditions towards acidic conditions.
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Affiliation(s)
- Gunda Mohanakrishna
- Department of Chemical Engineering, College of Engineering, Qatar University, PO Box 2713, Doha, Qatar; Separation & Conversion Technologies, VITO - Flemish Institute for Technological Research, Boeretang 200, 2400 Mol, Belgium
| | - Ibrahim M Abu Reesh
- Department of Chemical Engineering, College of Engineering, Qatar University, PO Box 2713, Doha, Qatar
| | - Karolien Vanbroekhoven
- Separation & Conversion Technologies, VITO - Flemish Institute for Technological Research, Boeretang 200, 2400 Mol, Belgium; Centre for Advanced Process Technology for Urban Resource Recovery (CAPTURE), 9000 Ghent, Belgium
| | - Deepak Pant
- Separation & Conversion Technologies, VITO - Flemish Institute for Technological Research, Boeretang 200, 2400 Mol, Belgium; Centre for Advanced Process Technology for Urban Resource Recovery (CAPTURE), 9000 Ghent, Belgium.
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Abstract
This report presents the case of a young man of 24 years old with Asperger syndrome who ingest quantities of medication whose flecainide. Resume of his stay in intensive care unit, notably serious adverse effect which ventricular tachycardia with membrane stabilizing effect and lengthening of stay in intensive care unit. Study of literature of different take care already published, with notion of mid-term leaching of flecainide which were ingest days before, at different levels all over the world.
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Affiliation(s)
- H Bensussan
- Cardiologie, DES de cardiologie et médecine vasculaire, CHU de Tours, avenue de la République, 37170 Chambray les Tours, France.
| | - K Mhamdi
- Réanimation polyvalente, centre hospitalier de Dreux, 44, avenue du Président-John-Fitzgerald-Kennedy, 28100 Dreux, France
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Litou C, Psachoulias D, Vertzoni M, Dressman J, Reppas C. Measuring pH and Buffer Capacity in Fluids Aspirated from the Fasted Upper Gastrointestinal Tract of Healthy Adults. Pharm Res 2020; 37:42. [PMID: 31989335 DOI: 10.1007/s11095-019-2731-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The design of biorelevant conditions for in vitro evaluation of orally administered drug products is contingent on obtaining accurate values for physiologically relevant parameters such as pH, buffer capacity and bile salt concentrations in upper gastrointestinal fluids. METHODS The impact of sample handling on the measurement of pH and buffer capacity of aspirates from the upper gastrointestinal tract was evaluated, with a focus on centrifugation and freeze-thaw cycling as factors that can influence results. Since bicarbonate is a key buffer system in the fasted state and is used to represent conditions in the upper intestine in vitro, variations on sample handling were also investigated for bicarbonate-based buffers prepared in the laboratory. RESULTS Centrifugation and freezing significantly increase pH and decrease buffer capacity in samples obtained by aspiration from the upper gastrointestinal tract in the fasted state and in bicarbonate buffers prepared in vitro. Comparison of data suggested that the buffer system in the small intestine does not derive exclusively from bicarbonates. CONCLUSIONS Measurement of both pH and buffer capacity immediately after aspiration are strongly recommended as "best practice" and should be adopted as the standard procedure for measuring pH and buffer capacity in aspirates from the gastrointestinal tract. Only data obtained in this way provide a valid basis for setting the physiological parameters in physiologically based pharmacokinetic models.
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Affiliation(s)
- Chara Litou
- Institute of Pharmaceutical Technology, Biocenter, Johann Wolfgang Goethe University, Max von Laue St. 9, 60438, Frankfurt am Main, Germany
| | - Dimitrios Psachoulias
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84, Zografou, Greece.,Drug Products and MDD III, Lavipharm S.A., Athens, Greece
| | - Maria Vertzoni
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84, Zografou, Greece
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Biocenter, Johann Wolfgang Goethe University, Max von Laue St. 9, 60438, Frankfurt am Main, Germany. .,Fraunhofer IME, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Christos Reppas
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 157 84, Zografou, Greece.
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Hirai K, Minato S, Kaneko S, Yanai K, Ishii H, Kitano T, Shindo M, Miyazawa H, Ito K, Ueda Y, Kaku Y, Hoshino T, Watano T, Fujino S, Ookawara S, Omoto K, Morishita Y. Approximation of bicarbonate concentration using serum total carbon dioxide concentration in patients with non-dialysis chronic kidney disease. Kidney Res Clin Pract 2019; 38:326-335. [PMID: 31378012 PMCID: PMC6727891 DOI: 10.23876/j.krcp.19.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background We investigated the relationship between serum total carbon dioxide (CO2) and bicarbonate ion (HCO3−) concentrations in pre-dialysis chronic kidney disease (CKD) patients and devised a formula for predicting low bicarbonate (HCO3−< 24 mmol/L) and high bicarbonate (HCO3− ≥ 24 mmol/L) using clinical parameters. Methods In total, 305 samples of venous blood collected from 207 pre-dialysis patients assessed by CKD stage (G1 + G2, 46; G3, 50; G4, 51; G5, 60) were investigated. The relationship between serum total CO2 and HCO3− concentrations was analyzed using Pearson’s correlation coefficient. An approximation formula was developed using clinical parameters correlated independently with HCO3− concentration. Diagnostic accuracy of serum total CO2 and the approximation formula was evaluated by receiver operating characteristic curve analysis and a 2 × 2 table. Results Serum total CO2 correlated strongly with HCO3− concentration (r = 0.91; P < 0.001). The following approximation formula was obtained by a multiple linear regression analysis: HCO3− (mmol/L) = total CO2 − 0.5 × albumin − 0.1 × chloride − 0.01 × (estimated glomerular filtration rate + blood glucose) + 15. The areas under the curves of serum total CO2 and the approximation formula for detection of low bicarbonate and high bicarbonate were 0.981, 0.996, 0.993, and 1.000, respectively. This formula had superior diagnostic accuracy compared with that of serum total CO2 (86.6% vs. 81.3%). Conclusion Serum total CO2 correlated strongly with HCO3− concentration in pre-dialysis CKD patients. An approximation formula including serum total CO2 showed superior diagnostic accuracy for low and high bicarbonate compared with serum total CO2.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Saori Minato
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Shohei Kaneko
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Katsunori Yanai
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Hiroki Ishii
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Mitsutoshi Shindo
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Yuichirou Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Yoshio Kaku
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Taro Hoshino
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Tatsuro Watano
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shinji Fujino
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama, Japan
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Navaneethan SD, Shao J, Buysse J, Bushinsky DA. Effects of Treatment of Metabolic Acidosis in CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2019; 14:1011-1020. [PMID: 31196951 PMCID: PMC6625635 DOI: 10.2215/cjn.13091118] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/04/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Metabolic acidosis is associated with progression of CKD and has significant adverse effects on muscle and bone. A systematic review and meta-analysis was conducted to evaluate the benefits and risks of metabolic acidosis treatment with oral alkali supplementation or a reduction of dietary acid intake in those with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS MEDLINE, Embase, and Cochrane CENTRAL were searched for relevant trials in patients with stage 3-5 CKD and metabolic acidosis (<22 mEq/L) or low-normal serum bicarbonate (22-24 mEq/L). Data were pooled in a meta-analysis with results expressed as weighted mean difference for continuous outcomes and relative risk for categorical outcomes with 95% confidence intervals (95% CIs), using a random effects model. Study quality and strength of evidence were assessed using Cochrane risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS Fourteen clinical trials were included (n=1394 participants). Treatment of metabolic acidosis with oral alkali supplementation or a reduction of dietary acid intake increased serum bicarbonate levels (14 studies, 1378 patients, mean difference 3.33 mEq/L, 95% CI, 2.37 to 4.29) and resulted in a slower decline in eGFR (13 studies, 1329 patients, mean difference -3.28 ml/min per 1.73 m2, 95% CI, -4.42 to -2.14; moderate certainty) and a reduction in urinary albumin excretion (very-low certainty), along with a reduction in the risk of progression to ESKD (relative risk, 0.32; 95% CI, 0.18 to 0.56; low certainty). Oral alkali supplementation was associated with worsening hypertension or the requirement for increased antihypertensive therapy (very-low certainty). CONCLUSIONS Low-to-moderate certainty evidence suggest that oral alkali supplementation or a reduction in dietary acid intake may slow the rate of kidney function decline and potentially reduce the risk of ESKD in patients with CKD and metabolic acidosis.
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Affiliation(s)
- Sankar D. Navaneethan
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jun Shao
- Tricida, Inc., South San Francisco, CA; and
| | | | - David A. Bushinsky
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Kendrick J, Shah P, Andrews E, You Z, Nowak K, Pasch A, Chonchol M. Effect of Treatment of Metabolic Acidosis on Vascular Endothelial Function in Patients with CKD: A Pilot Randomized Cross-Over Study. Clin J Am Soc Nephrol 2018; 13:1463-1470. [PMID: 30237219 PMCID: PMC6218835 DOI: 10.2215/cjn.00380118] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/08/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES We examined the effect of alkali replacement for metabolic acidosis on vascular endothelial function in patients with CKD. METHODS We performed a pilot, prospective, open-label 14-week crossover study examining the effect of oral sodium bicarbonate treatment on vascular function in 20 patients with an eGFR of 15-44 ml/min per 1.73 m2 with low serum bicarbonate levels (16-21 mEq/L). Each period was 6 weeks in duration with a 2-week washout period in between. Patients were treated to goal serum bicarbonate of ≥23 mEq/L. The primary end point was change in brachial artery flow-mediated dilation (FMD) between treatment and control conditions. Secondary end points included changes in markers of inflammation, bone turnover, mineral metabolism, and calcification. RESULTS Eighteen patients completed the study and were included in the primary efficacy analysis. The mean (SD) age and eGFR were 59 (12) years and 26 (8) ml/min per 1.73 m2, respectively. Serum bicarbonate increased significantly with sodium bicarbonate treatment (+2.7±2.9 mEq/L, P≤0.001), whereas there was no change in bicarbonate levels in the control group. FMD significantly improved after sodium bicarbonate therapy (mean±SD, FMD baseline: 4.1%±4.1%; 6 weeks: 5.2%±2.9%; P=0.04) There was no significant change in FMD in the control group (mean±SD, FMD baseline: 4.6%±3.1%; 6 weeks: 4.1%±3.4%; P=0.20). Compared with control, sodium bicarbonate treatment resulted in a significant increase in FMD (mean, 1.8%; 95% confidence interval, 0.3 to 3.3; P=0.02). There was no significant change in bone markers or serum calcification propensity with treatment. Serum phosphorus and intact fibroblast growth factor 23 increased significantly during treatment. CONCLUSIONS Treatment of metabolic acidosis with sodium bicarbonate significantly improved vascular endothelial function in patients with stages 3b and 4 CKD.
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Affiliation(s)
- Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
| | - Pratik Shah
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
| | - Emily Andrews
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
| | - Kristen Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
| | - Andreas Pasch
- Department of Biomedical Research, University of Bern and Calciscon, Bern, Switzerland
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado; and
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Bressendorff I, Hansen D, Schou M, Pasch A, Brandi L. The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease: A Randomized, Controlled Clinical Trial. Clin J Am Soc Nephrol 2018; 13:1373-1380. [PMID: 30131425 PMCID: PMC6140556 DOI: 10.2215/cjn.13921217] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T50, the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T50 represents higher calcification propensity and is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases T50, but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on T50 in subjects undergoing hemodialysis for ESKD. The primary end point was the value of T50 at the end of the intervention. RESULTS Fifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, T50 was 233±81 minutes (mean±SD) at baseline (mean of days -7 and 0) and 229±93 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, T50 was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in T50 between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; P<0.001), and the between-group difference in serum magnesium was 0.88 mg/dl (95% confidence interval, 0.66 to 1.10; P=0.001). CONCLUSIONS Increasing dialysate magnesium increases T50 and hence, decreases calcification propensity in subjects undergoing maintenance hemodialysis. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_21_CJASNPodcast_18_9_B.mp3.
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Affiliation(s)
- Iain Bressendorff
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital, Hillerod, Denmark
- Departments of Nephrology and
| | | | - Morten Schou
- Cardiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Andreas Pasch
- Department of Biomedical Research, University of Bern, Bern, Switzerland; and
- Calciscon AG, Bern, Switzerland
| | - Lisbet Brandi
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital, Hillerod, Denmark
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Zhang S, Qing SM, Liu H, Zhang NF. [Effect of HCO 3- level on the accuracy of NoSAS screening for obstructive sleep apnea hypopnea syndrome]. Zhonghua Yi Xue Za Zhi 2018; 98:2564-2568. [PMID: 30220140 DOI: 10.3760/cma.j.issn.0376-2491.2018.32.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effect of arterial blood HCO3- level on the accuracy of NoSAS questionnaire screening for obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: The hospitalized patients with suspected OSAHS were recruited from March 2016 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. NoSAS scores, blood gas analysis and polysomnography (PSG) were performed in these patients. Patients were divided into non OSAHS group and mild, moderate and severe OSAHS group according to the PSG results. According to the NoSAS questionnaire score, the patients were divided into OSAHS high-risk group and low risk group. The correlation between arterial blood HCO3- level and apnea hypopnea index (AHI) was analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the accuracy of HCO3- prediction OSAHS. Predictive parameters(sensitivity, specificity, positive and negative predictive values)for NoSAS scores and HCO3- level were calculated. Results: A total of 243 patients with suspected OSAHS were included, including 186 males (76.5%), 57 females (23.5%), age (49±13) years, body mass index (BMI) (26.9±4.4) kg/m2, and neck circumference (38.6±4.5) cm. The HCO3- level was positively correlated with AHI (r=0.206, P=0.001). The proportion of patients with HCO3- level ≥26 mmol/L in non-OSAHS group was lower than that in OSAHS group (13.0% vs 34.5%, P=0.004); the proportion of patients with HCO3- level ≥26 mmol/L in severe OSAHS group was higher than that in mild OSAHS group (37.7% vs 15.0%, P=0.008), and there was no difference in the ratio of patients with severe OSAHS and moderate OSAHS (37.7% vs 35.3%, P=0.767). The specificity of OSAHS predicted by HCO3- level 25 and 26 mmol/L was 69.6% and 87.0%, respectively. With the NoSAS score of 8 or 7 as cutoffs for analysis, the sensitivity for OSAHS was 61.9% and 79.2%, the specificity for OSAHS was 57.4% and 40.4%, respectively. With the addition of HCO3- level ≥ 26 mmol/L to the NoSAS score ≥ 7, the specificity for OSAHS improved to 93.6%, while the sensitivity decreased to 27.4%. Conclusion: Combined with the arterial blood HCO3- level, the specificity of the NoSAS questionnaire increases and the sensitivity decreases.
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Affiliation(s)
- S Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Affiliation(s)
- Stephen M. Sozio
- Division of Nephrology, Department of Medicine and
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
| | - Mara McAdams-DeMarco
- Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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12
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Dobre M, Gaussoin SA, Bates JT, Chonchol MB, Cohen DL, Hostetter TH, Raphael KL, Taylor AA, Lerner AJ, Wright JT, Rahman M. Serum Bicarbonate Concentration and Cognitive Function in Hypertensive Adults. Clin J Am Soc Nephrol 2018; 13:596-603. [PMID: 29567858 PMCID: PMC5968905 DOI: 10.2215/cjn.07050717] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/05/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive function worsens as kidney function declines, but mechanisms contributing to this association are not completely understood. Metabolic acidosis, a common complication of CKD, leads to neural networks overexcitation and is involved in cerebral autoregulation. We aimed to evaluate the association between serum bicarbonate concentration as a measure of metabolic acidosis, and cognitive function in hypertensive adults with and without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Five cognitive summary scores were measured (global cognitive function, executive function, memory, attention/concentration, and language) in 2853 participants in the Systolic BP Intervention Trial (SPRINT). Multivariable linear regression models adjusted for demographics, comorbidities, systolic BP, medications, eGFR and albuminuria evaluated the cross-sectional association between bicarbonate and cognition at SPRINT baseline. In a subset (n=681) who underwent brain magnetic resonance imaging, the models were adjusted for white matter hyperintensity volume, vascular reactivity, and cerebral blood flow. RESULTS The mean age (SD) was 68 (8.5) years. Global cognitive and executive functions were positively associated with serum bicarbonate (estimate [SEM]: 0.014 [0.006]; P=0.01, and 0.018 [0.006]; P=0.003, respectively). Each 1 mEq/L lower bicarbonate level had a similar association with global cognitive and executive function as being 4.3 and 5.4 months older, respectively. The association with global cognition persisted after magnetic resonance imaging findings adjustment (estimate [SEM]: 0.03 [0.01]; P=0.01). There was no association between serum bicarbonate level and memory, attention/concentration, and language. CONCLUSIONS In a large cohort of hypertensive adults, higher serum bicarbonate levels were independently associated with better global cognitive and executive performance. (ClinicalTrials.gov: NCT01206062).
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Affiliation(s)
- Mirela Dobre
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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13
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Rivara MB, Ravel V, Streja E, Obi Y, Soohoo M, Cheung AK, Himmelfarb J, Kalantar-Zadeh K, Mehrotra R. Weekly Standard Kt/V urea and Clinical Outcomes in Home and In-Center Hemodialysis. Clin J Am Soc Nephrol 2018; 13:445-455. [PMID: 29326306 PMCID: PMC5967669 DOI: 10.2215/cjn.05680517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing hemodialysis with a frequency other than thrice weekly are not included in current clinical performance metrics for dialysis adequacy. The weekly standard Kt/Vurea incorporates treatment frequency, but there are limited data on its association with clinical outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used multivariable regression to examine the association of dialysis standard Kt/Vurea with BP and metabolic control (serum potassium, calcium, bicarbonate, and phosphorus) in patients incidental to dialysis treated with home (n=2373) or in-center hemodialysis (n=109,273). We further used Cox survival models to examine the association of dialysis standard Kt/Vurea with mortality, hospitalization, and among patients on home hemodialysis, transfer to in-center hemodialysis. RESULTS After adjustment for potential confounders, patients with dialysis standard Kt/Vurea <2.1 had higher BPs compared with patients with standard Kt/Vurea 2.1 to <2.3 (3.4 mm Hg higher [P<0.001] for home hemodialysis and 0.9 mm Hg higher [P<0.001] for in-center hemodialysis). There were no clinically meaningful associations between dialysis standard Kt/Vurea and markers of metabolic control, irrespective of dialysis modality. There was no association between dialysis standard Kt/Vurea and risk for mortality, hospitalization, or transfer to in-center hemodialysis among patients undergoing home hemodialysis. Among patients on in-center hemodialysis, dialysis standard Kt/Vurea <2.1 was associated with higher risk (adjusted hazard ratio, 1.11; 95% confidence interval, 1.07 to 1.14) and standard Kt/Vurea ≥2.3 was associated with lower risk (adjusted hazard ratio, 0.97; 95% confidence interval, 0.94 to 0.99) for death compared with standard Kt/Vurea 2.1 to <2.3. Additional analyses limited to patients with available data on residual kidney function showed similar relationships of dialysis and total (dialysis plus kidney) standard Kt/Vurea with outcomes. CONCLUSIONS Current targets for standard Kt/Vurea have limited utility in identifying individuals at increased risk for adverse clinical outcomes for those undergoing home hemodialysis but may enhance risk stratification for in-center hemodialysis.
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Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington
| | - Vanessa Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Alfred K. Cheung
- Division of Nephrology & Hypertension, University of Utah, Salt Lake City, Utah
| | - Jonathan Himmelfarb
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California; and
| | - Rajnish Mehrotra
- Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington
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14
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Raphael KL, Gilligan S, Hostetter TH, Greene T, Beddhu S. Association between Urine Ammonium and Urine TGF- β1 in CKD. Clin J Am Soc Nephrol 2018; 13:223-230. [PMID: 29146699 PMCID: PMC5967432 DOI: 10.2215/cjn.07510717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Urinary ammonium excretion increases in response to nonvolatile acids to maintain normal systemic bicarbonate and pH. However, enhanced ammonia production promotes tubulointerstitial fibrosis in animal models. Therefore, a subset of individuals with CKD and normal bicarbonate may have acid-mediated kidney fibrosis that might be better linked with ammonium excretion than bicarbonate. We hypothesized that urine TGF-β1, as an indicator of kidney fibrosis, would be more tightly linked with urine ammonium excretion than serum bicarbonate and other acid-base indicators. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured serum bicarbonate and urinary ammonium, titratable acids, pH, and TGF-β1/creatinine in 144 persons with CKD. Multivariable-adjusted linear regression models determined the cross-sectional association between TGF-β1/creatinine and serum bicarbonate, urine ammonium excretion, urine titratable acids excretion, and urine pH. RESULTS Mean eGFR was 42 ml/min per 1.73 m2, mean age was 65 years old, 78% were men, and 62% had diabetes. Mean urinary TGF-β1/creatinine was 102 (49) ng/g, mean ammonium excretion was 1.27 (0.72) mEq/h, mean titratable acids excretion was 1.14 (0.65) mEq/h, mean urine pH was 5.6 (0.5), and mean serum bicarbonate was 23 (3) mEq/L. After adjusting for eGFR, proteinuria, and other potential confounders, each SD increase of urine ammonium and urine pH was associated with a statistically significant 1.22-fold (95% confidence interval, 1.11 to 1.35) or 1.11-fold (95% confidence interval, 1.02 to 1.21) higher geometric mean urine TGF-β1/creatinine, respectively. Each SD increase of serum bicarbonate and urine titratable acids was associated with a nonsignificant 1.06-fold (95% confidence interval, 0.97 to 1.16) or 1.03-fold (95% confidence interval, 0.92 to 1.14) higher geometric mean urine TGF-β1/creatinine, respectively. CONCLUSIONS Urinary ammonium excretion but not serum bicarbonate is associated with higher urine TGF-β1/creatinine.
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Affiliation(s)
- Kalani L. Raphael
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
- Medicine Section and Research Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; and
| | - Sarah Gilligan
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Thomas H. Hostetter
- Department of Internal Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Tom Greene
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Srinivasan Beddhu
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
- Medicine Section and Research Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; and
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15
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Nagami GT, Hamm LL. Regulation of Acid-Base Balance in Chronic Kidney Disease. Adv Chronic Kidney Dis 2017; 24:274-279. [PMID: 29031353 DOI: 10.1053/j.ackd.2017.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/28/2017] [Indexed: 11/11/2022]
Abstract
The kidneys play a major role in the regulation of acid-base balance by reabsorbing bicarbonate filtered by the glomeruli and excreting titratable acids and ammonia into the urine. In CKD, with declining kidney function, acid retention and metabolic acidosis occur, but the extent of acid retention depends not only on the degree of kidney impairment but also on the dietary acid load. Acid retention can occur even when the serum bicarbonate level is apparently normal. With reduced kidney function, acid transport processes in the surviving nephrons are augmented but as disease progresses ammonia excretion and, in some individuals, the ability to reabsorb bicarbonate falls, whereas titratable acid excretion is preserved until kidney function is severely impaired. Urinary ammonia levels are used to gauge the renal response to acid loads and are best assessed by direct measurement of urinary ammonia levels rather than by indirect assessments. In individuals with acidosis from CKD, an inappropriately low degree of ammonia excretion points to the pathogenic role of impaired urinary acid excretion. The presence of a normal bicarbonate level in CKD complicates the interpretation of the urinary ammonia excretion as such individuals could be in acid-base balance or could be retaining acid without manifesting a low bicarbonate level. At this time, the decision to give bicarbonate supplementation in CKD is reserved for those with a bicarbonate level of 22 mEq/L, but because of potential harm of overtreatment, supplementation should be adjusted to maintain a bicarbonate level of <26 mEq/L.
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16
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Etezadi F, Najafi Abrandabadi AH, Motaharinia J, Mojtahedzadeh M, Pourfakhr P, Khajavi MR, Gooran S, Shariat Moharari R, Dehghani S. The Effect of Osmotherapy and Tight Control of Acidosis on Early Graft Function among Deceased-Donor Kidney Transplant Recipients: A Randomized Controlled Trial. Int J Organ Transplant Med 2017; 8:8-16. [PMID: 28299023 PMCID: PMC5347401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function. OBJECTIVE We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function. METHODS Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19). RESULTS Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p<0.05). However, that beneficial effect no longer remained at the same level after the day four. CONCLUSION Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.
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Affiliation(s)
- F. Etezadi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A. H. Najafi Abrandabadi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - J. Motaharinia
- Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Dr. Javad Motaharinia, Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98-919-995-2505, Fax: +98-21-2204-8483, E-mail:
| | - M. Mojtahedzadeh
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran ,Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - P. Pourfakhr
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M. R. Khajavi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S. Gooran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - R. Shariat Moharari
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S. Dehghani
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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17
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Chang KY, Kim HW, Kim WJ, Kim YK, Kim SH, Song HC, Kim YO, Jin DC, Choi EJ, Yang CW, Kim YL, Kim NH, Kang SW, Kim YS, Kim YS. The impact of high serum bicarbonate levels on mortality in hemodialysis patients. Korean J Intern Med 2017; 32:109-116. [PMID: 27044857 PMCID: PMC5214722 DOI: 10.3904/kjim.2015.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. METHODS Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO2) levels: quartile 1, a tCO2 of < 19.4 mEq/L; quartile 2, a tCO2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. RESULTS We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). CONCLUSIONS Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.
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Affiliation(s)
- Kyung Yoon Chang
- Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Woo Jeong Kim
- Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yong Kyun Kim
- College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Su-Hyun Kim
- Chung-Ang University College of Medicine, Seoul, Korea
| | - Ho Chul Song
- College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Young Ok Kim
- College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong Chan Jin
- Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Euy Jin Choi
- College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Chul Woo Yang
- College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong-Lim Kim
- Kyungpook National University School of Medicine, Daegu, Korea
| | - Nam-Ho Kim
- Chonnam National University Medical School, Gwangju, Korea
| | | | - Yon-Su Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Young Soo Kim
- College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
- Correspondence to Young Soo Kim, M.D. Division of Nephrology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: +82-31-820-3039 Fax: +82-31-847-2719 E-mail:
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18
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Citarda S, Hanf W, Vrigneaud L, Bataille S, Gosselin M, Beaume J, Dariane C, Madec FX, Larceneux F, Fiard G, Bertocchio JP. [Mineral-based alkaline waters' prescription in France: Patients are the key point for both nephrologists and urologists]. Nephrol Ther 2015; 12:38-47. [PMID: 26563589 DOI: 10.1016/j.nephro.2015.07.471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified.
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Affiliation(s)
- Salvatore Citarda
- Centre associatif lyonnais de dialyse (CALYDIAL), 51, rue Yvours, 69540 Irigny, France; Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France
| | - William Hanf
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie, centre hospitalier Alpes-Léman, 74130 Contamine-sur-Arve, France
| | - Laurence Vrigneaud
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de médecine interne et néphrologie, centre hospitalier de Valenciennes, avenue Desandrouin, 59300 Valenciennes, France
| | - Stanislas Bataille
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Institut phocéen de néphrologie, clinique Bouchard, 13006 Marseille, France
| | - Morgane Gosselin
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de néphrologie et transplantation rénale, CHRU La Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - Julie Beaume
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service de dialyse, HIA Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France
| | - Charles Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France; Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - François-Xavier Madec
- Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie infantile, hôpital Mère-Enfant, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Fabrice Larceneux
- Dauphine recherches en management, UMR CNRS 7088, université Paris Dauphine, place du Maréchal-de-Lattre-de-Tassigny, 75016 Paris, France
| | - Gaëlle Fiard
- Association française des urologues en formation, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Grenoble, laboratoire TIMC-IMAG, CNRS, université Grenoble-Alpes, 38000 Grenoble, France
| | - Jean-Philippe Bertocchio
- Club des jeunes néphrologues, 11, rue Auguste-Mourcou, 59000 Lille, France; Service d'explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris, France.
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Bacchetta J, Sellier-Leclerc AL, Bertholet-Thomas A, Carlier MC, Cartier R, Cochat P, Ranchin B. Calcium balance in pediatric online hemodiafiltration: Beware of sodium and bicarbonate in the dialysate. Nephrol Ther 2015; 11:483-6. [PMID: 26165800 DOI: 10.1016/j.nephro.2015.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/16/2015] [Accepted: 03/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Online hemodiafiltration (oHDF) is increasingly used in children; we treated 28 children since 2009, adapting this technique to pediatric patients. METHODS In this service evaluation audit, we assessed plasma electrolytes to evaluate the evolution of total (tCa) and ionized (iCa) during a session, as well as dialysate calcium (dCa) concentrations. RESULTS Using a 1.25 mmol Ca/L-dialysate, both tCa and iCa decreased during the session, with iCa falling below 1.1 mmol/L in 4/5 patients. In contrast, using a 1.5 mmol Ca/L-dialysate, iCa remained normal in all patients. Major discrepancies were observed between the expected and the measured dCa: 1.25 vs. 1.01 (0.83-1.04), and 1.5 vs. 1.47 (0.85-1.75) mmol/L, respectively (results presented as median [range]). These differences were explained by the modality of reconstituting dialysate: increasing bicarbonates and/or decreasing sodium requested in the dialysate decreases calcium extraction from the acid preparation. Proof of concept was given when requesting in an "ex-vivo" setting modifications in the requested sodium and bicarbonate in dialysate directly on the Fresenius machine. CONCLUSION Nephrologists should be aware that "high bicarbonate and/or low sodium" requirements in oHDF decrease calcium in the dialysate.
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Affiliation(s)
- Justine Bacchetta
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France; Université de Lyon, 69008 Bron, France.
| | - Anne-Laure Sellier-Leclerc
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Aurélia Bertholet-Thomas
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France
| | | | - Régine Cartier
- Département de biologie, hospices civils de Lyon, 69677 France
| | - Pierre Cochat
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France; Université de Lyon, 69008 Bron, France
| | - Bruno Ranchin
- Centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France
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20
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Kim BR, Park SJ, Shin HS, Jung YS, Rim H. Correlation between peripheral venous and arterial blood gas measurements in patients admitted to the intensive care unit: A single-center study. Kidney Res Clin Pract 2013; 32:32-8. [PMID: 26889435 PMCID: PMC4716110 DOI: 10.1016/j.krcp.2013.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/03/2013] [Accepted: 01/09/2013] [Indexed: 11/06/2022] Open
Abstract
Background The objective of this study was to examine the correlation between arterial blood gas (ABG) and peripheral venous blood gas (VBG) samples for all commonly used parameters in patients admitted to a medical intensive care unit (ICU). Methods A single-center, prospective trial was carried out in a medical ICU in order to determine the level of correlation of ABG and peripheral VBG measurements. A maximum of five paired ABG–VBG samples were obtained per patient to prevent a single patient from dominating the data set. Results Regression equations were derived to predict arterial values from venous values as follows: arterial pH=−1.108+1.145×venous pH+0.008×PCO2−0.012×venous HCO3+0.002×venous total CO2 (R2=0.655), arterial PCO2=88.6−10.888×venous pH+0.150×PCO2+0.812×venous HCO3+0.124×venous total CO2 (R2=0.609), arterial HCO3=−89.266+12.677×venous pH+0.042×PCO2+0.675×venous HCO3+0.185×venous total CO2 (R2=0.782). The mean ABG minus peripheral VBG differences for pH, PCO2, and bicarbonates were not clinically important for between–person heterogeneity. Conclusion Peripheral venous pH, PCO2, bicarbonates, and total CO2 may be used as alternatives to their arterial equivalents in many clinical contexts encountered in the ICU.
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Affiliation(s)
- Bo Ra Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sae Jin Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeon Soon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Abdollahi H, Tadjrobehkar O. The role of different sugars, amino acids and few other substances in chemotaxis directed motility of helicobacter pylori. Iran J Basic Med Sci 2012; 15:787-94. [PMID: 23492866 PMCID: PMC3586890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 11/25/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Motility plays a major role in pathogenicity of Helicobacter pylori, yet there is scarce data regarding its chemotactic behaviour. The present study was designed to investigate the chemotactic responses of local isolates of H. pylori towards various sugars, amino acids, as well as some other chemical substances. MATERIALS AND METHODS Chemotaxis was assayed by a modified Adler's method. We used solutions of sugars, amino acids as well as urea, sodium chloride, sodium and potassium bicarbonate, sodium deoxycholate and keratin at 10 mM concentrations. RESULTS Despite some small differences, tested H. pylori isolates generally had a positive chemotaxis towards the tested sugars (P< 0.05). Among amino acids, phenylalanine, aspartic acid, glutamic acid, isoleucine and leucine showed a positive chemotaxis (P< 0.05) ; however, tyrosine showed negative chemotaxis (repellent) (P< 0.15). Urea, sodium chloride, sodium and potassium bicarbonate showed to be attractants (P< 0.05), but sodium deoxycholate was repellent (P< 0.05). CONCLUSION It seems that, sugars and many amino acids by their attraction for H.pylori, many amino acids, may enhance the activity of this bacterium and probably aggravate the symptoms of its infection. However, those like L-tyrosine, may possibly be employed as deterrents for H. pylori and thus can control its infections. However, we suggest that further investigations on chemotactic behaviour of many more strains of H. pylori should be carried out before a final conclusion.
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Affiliation(s)
- Hamid Abdollahi
- Microbiology Department, Medical School, Kerman University of Medical Sciences, Kerman, Iran
| | - Omid Tadjrobehkar
- Microbiology Department, Medical School, Kerman University of Medical Sciences, Kerman, Iran and Basic Sciences Department, Medical School , Zabol University of Medical Sciences, Zabol , Iran,Corresponding author: Tel: +98-341-3221665; Fax: +98-341-3221665;
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