Abstract
Background
Acid-base balance is maintained by kidney excretion of titratable acids and bicarbonate reabsorption. Metabolic alkalosis is uncommon in dialysis-treated patients. The aim of this retrospective study was to assess the rate of metabolic alkalosis in pediatric patients treated with peritoneal dialysis.
Methods
Medical records of children treated with peritoneal dialysis in Shaare Zedek Medical Center from January 2000 to June 2021 were reviewed and compared with young adults currently treated with peritoneal dialysis. Demographic, clinical, and peritoneal dialysis characteristics were extracted from the medical records.
Results
Thirty chronic peritoneal dialysis patients were included in our study, seven under 2 years, 13 between 2 and 18 years, and 10 adults. 90.3% of the measurements in infants showed metabolic alkalosis compared to 32.3% in the 2–18-year group and none in the adult group. Higher size-adjusted daily exchange volume, lack of urine output, and high lactate-containing dialysate were associated with metabolic alkalosis. Alkalosis was not explained by vomiting, diuretic therapy, or carbonate-containing medications. High transport membrane, low dietary protein, and malnutrition, all previously reported explanations for metabolic alkalosis, were not found in our study.
Conclusions
Metabolic alkalosis is common in infants treated with peritoneal dialysis as opposed to older children and adults. High lactate-containing dialysate is a possible explanation. Higher size-adjusted daily dialysate exchange volume, which may reflect higher bicarbonate absorption, is another independent predictor of alkalosis. Acid-base status should be closely followed in infants, and using a dialysis solution with lower bicarbonate or lactate level should be considered.
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Availability of data and material
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Abbreviations
- CKD:
-
Chronic kidney disease
- GFR:
-
Glomerular filtration rate
- PD:
-
Peritoneal dialysis
- IRB:
-
Institutional Review Board
- PET:
-
Peritoneal equilibration test
- nPCR:
-
Normalized protein catabolic rate
- WHO:
-
World Health Organization
- CDC:
-
Centers for Disease Control and Prevention
- BMI:
-
Body mass index
- NIH:
-
National Institute of Health
- NKF KDOQI:
-
National Kidney Foundation Kidney Disease Outcomes Quality Initiative
- BSA:
-
Body surface area
- SD:
-
Standard deviation
- IQR:
-
Interquartile range
- CAPD:
-
Continuous ambulatory peritoneal dialysis
- APD:
-
Automated peritoneal dialysis
- HD:
-
Hemodialysis
- DRI:
-
Dietary reference intake
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Contributions
STB and EBS contributed to the study conception and design. STB, AB, and EBS performed data collection and analysis. The first draft of the manuscript was written by STB, and AB, RBC, CR, JWG, SC, LS, YF, and EBS commented on previous versions of the manuscript. All authors read and approved the final manuscript. As the corresponding author, Shimrit Tzvi-Behr confirms that the manuscript has been read and approved for submission by all the named authors.
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The study was approved by the Institutional Review Board (IRB) at the Shaare Zedek Medical Center (Approval number: 0272-19-SZMC). We declare that this manuscript is original, has not been published before, and is not currently being considered for publication elsewhere.
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The authors declare no competing interests.
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Tzvi-Behr, S., Bnaya, A., Becker-Cohen, R. et al. Metabolic alkalosis in infants treated with peritoneal dialysis. Pediatr Nephrol 37, 1889–1895 (2022). https://doi.org/10.1007/s00467-021-05344-w
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DOI: https://doi.org/10.1007/s00467-021-05344-w