Pufferung durch Dialyseverfahren – Hintergründe und Auswirkungen auf den Patienten

Die metabolische Azidose kann durch Dialyseverfahren beeinflusst werden. Bei der Hämodialyse sind langfristig hohe Bikarbonatkonzentrationen (> 37 mmol/l) im Dialysat mit einer höheren Mortalität assoziiert. Die Dialysatzusammensetzung und insbesondere die Bikarbonatkonzentration sollten individualisiert verordnet werden. Ein hohes Dialysatbikarbonat und ein tiefes Dialysatkalium bergen das Risiko einer profunden Hypokaliämie und damit einhergehender Herz-Rhythmus-Probleme. Bei einer persistierenden metabolischen Azidose sind die Ernährungstherapie und die orale Bikarbonatsupplementation Therapieoptionen. Determinanten des Säure-Basen-Status bei Dialysepatienten sind die Proteinzufuhr, die Katabolierate und der interdialytische Gewichtszuwachs.

Metabolic acidosis can be influenced by dialysis procedures. In hemodialysis, long-term high bicarbonate concentrations (>37mmol/l) in the dialysate are associated with a higher mortality. Dialysate composition and especially bicarbonate concentration should be prescribed individually. A high dialysate bicarbonate and a low dialysate potassium contain the risk of a profound hypokalemia and heart rhythm problems coming along with this. In persistent metabolic acidosis, nutrition therapy and oral bicarbonate supplementation are therapeutic options. Determinants of acid-base status in dialysis patients are protein supply, catabolic rate and interdialytic weight gain.

Key words

buffering - dialysis procedures - metabolic acidosis - bicarbonate concentration - acid-base status

• Literatur

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