Longitudinal Changes in Acid-Base Parameters From Dialysis Initiation to Death in Maintenance Hemodialysis Patients.
Publisher DOI
PubMed ID
42496588
Abstract
Introduction
Blood gas analysis is routinely performed in hemodialysis patients to monitor acid-base status and serum potassium. Despite frequent testing, longitudinal analyses of acid-base parameters over patients' lifetime are lacking.Methods
We conducted a retrospective analysis of 45 chronic hemodialysis patients at a secondary dialysis center in Austria, including 7946 blood gas analyses. Acid-base disturbances and respiratory compensation to metabolic acidosis were evaluated. Longitudinal changes were assessed at three time points: START (4 weeks after dialysis initiation), MID (mid-survival), and EOL (last 4 weeks of dialysis). Four measurements per patient were included at each time point. Venous blood gas values were adjusted to arterial equivalents to improve comparability. Linear mixed-effects models were used for analysis.Findings
Venous blood gas analysis systematically misclassified respiratory status; standard formulas for compensation (e.g., Winter's formula) were not applicable. Over the course of dialysis treatment, acid-base and electrolyte homeostasis changed significantly. Temporal patterns were largely comparable between expected and unexpected death, with the exception of lactate, which increased significantly in patients with unexpected death.Discussion
This study provides a comprehensive longitudinal evaluation of acid-base parameters from dialysis initiation to death. Observed temporal patterns, particularly in patients with unexpected death, suggest distinct terminal metabolic trajectories. These findings warrant further investigation in larger cohorts, potentially supported by artificial intelligence-based analyses.
Blood gas analysis is routinely performed in hemodialysis patients to monitor acid-base status and serum potassium. Despite frequent testing, longitudinal analyses of acid-base parameters over patients' lifetime are lacking.Methods
We conducted a retrospective analysis of 45 chronic hemodialysis patients at a secondary dialysis center in Austria, including 7946 blood gas analyses. Acid-base disturbances and respiratory compensation to metabolic acidosis were evaluated. Longitudinal changes were assessed at three time points: START (4 weeks after dialysis initiation), MID (mid-survival), and EOL (last 4 weeks of dialysis). Four measurements per patient were included at each time point. Venous blood gas values were adjusted to arterial equivalents to improve comparability. Linear mixed-effects models were used for analysis.Findings
Venous blood gas analysis systematically misclassified respiratory status; standard formulas for compensation (e.g., Winter's formula) were not applicable. Over the course of dialysis treatment, acid-base and electrolyte homeostasis changed significantly. Temporal patterns were largely comparable between expected and unexpected death, with the exception of lactate, which increased significantly in patients with unexpected death.Discussion
This study provides a comprehensive longitudinal evaluation of acid-base parameters from dialysis initiation to death. Observed temporal patterns, particularly in patients with unexpected death, suggest distinct terminal metabolic trajectories. These findings warrant further investigation in larger cohorts, potentially supported by artificial intelligence-based analyses.
Date Issued
2026-07-24
Publication Type
Article
Subjects
acid–base
•
blood gas analysis
•
hemodialysis
•
lifetime
Language(s)
en
Author(s)
Schwarz, Christoph | |
Pirklbauer, Markus |
Additional Credits
Journal
Hemodialysis International
Publisher
Wiley
ISSN
1542-4758
1492-7535
Access(Rights)
restricted