OBJECTIVE: To assess the nutritional effect of correcting metabolic acidosis in hemodialysis patients. METHODS: Twenty patients with metabolic acidosis, defined as mean serum bicarbonate < 22 mEq/L before dialysis, were studied for six months. They had been on dialysis for at least six months, with 35 mEq/L of bicarbonate in the dialysate. Metabolic acidosis was corrected through elevation in dialysate bicarbonate to values not exceeding 40 mEq/L, aiming at bicarbonate serum levels between 22 and 26 mEq/L. Biochemical, anthropometric, and dietary assessments were performed at the beginning and end of the study, as was Global Subjective Assessment (GSA). RESULTS: The nutritional assessment in the initial phase of the study showed normal body mass index (24.23 ± 3.83 kg/m²). However, according to arm muscle circumference, triceps skinfold, and GSA, men and women were classified as undernourished. Calorie and protein intakes were 29.7 ± 10.1 kcal/kg/day and 1.31 ± 0.35 g/kg/day, respectively. The biochemical evaluation showed normal serum albumin and low cholesterol. After correction, serum bicarbonate and pH increased from 18.2 ± 1.64 to 22 ± 1.70 (p < 0.001) and from 7.32 ± 0.45 to 7.37 ± 0.41 (p < 0.001), respectively. GSA improved (21.7 ± 6.4 versus 16.8 ± 6.6, p < 0.001) and calorie intake increased (1892 ± 454.30 versus 2110.30 ± 869.24, p < 0.05). CONCLUSIONS: Bicarbonate supplementation in hemodialysis solution was effective for correcting metabolic acidosis, determining an increase in calorie intake and improvement in GSA scores.
hemodialysis; metabolic acidosis; nutritional status
