Do you adjust the hemodialysis bicarbonate bath to match the elevated serum bicarbonate level in ESKD patients with hypercarbia due to COPD?

I do not typically for COPD itself, but I do consider it in circumstances where there is severe resp acidemia with no other options for stabilizing their pH. In a subset of patients on home ventilation/AVAPS, they have little reserve to handle even a little more CO2 retention. I will modulate the di...

• Generally speaking, hypercarbia in dialysis patients is rarely related to COPD since this will require a reasonable residual kidney function to be able to generate the bicarbonate. GI losses is the primary cause usually. Increasing dialysis bicarbonate level would not help.

Lisawat P, Gennari FJ. Ap...

Good question. Not much data. My answer would be yes, with some exceptions. The body's natural response to hypercarbia is to retain bicarbonate and maintain the pH (people with normal renal function). I would guess it would be beneficial to do the same thing with dialysis when the kidneys are unable...

Generally not. The concentration of dialysate bicarbonate in most hemodialysis centers in the US is about 35 mmol/l. Therefore, for most COPD hyperbaric patients with a serum bicarbonate 33-37 mmol/ there will be no net flux of bicarbonate into or out dialysate and no adjustment of dialysate bicarbo...