{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T01:54:24Z","timestamp":1776995664539,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,3,13]],"date-time":"2017-03-13T00:00:00Z","timestamp":1489363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ther Apher Dial"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Fresenius Medical Care's NaturaLyte dialysate has been associated with increased risk of sudden cardiac death by causing metabolic alkalosis from its acetate content based on retrospective data using pre\u2010dialysis bicarbonate levels only. The study objective was to measure inter\/intra\u2010dialytic changes in serum bicarbonate and degree of alkalosis conferred by varying concentrations of NaturaLyte bicarbonate dialysate. Thirty\u2010nine hemodialysis patients were divided into four groups based on prescribed bicarbonate dialysate concentrations; Group 1 (<jats:italic>N\u00a0=<\/jats:italic>\u00a09): 30\u201332\u00a0mEq\/L, Group 2 (<jats:italic>N\u00a0=<\/jats:italic>\u00a05): 33\u201334\u00a0mEq\/L, Group 3 (<jats:italic>N\u00a0=<\/jats:italic>\u00a010): 35\u201336\u00a0mEq\/L, Group 4 (<jats:italic>N\u00a0=<\/jats:italic>\u00a015): 37\u201340\u00a0mEq\/L. Serial (pre\u2010dialysis, immediate post\u2010dialysis, 2\u00a0h post\u2010dialysis, and 68\u00a0h post\u2010dialysis) bicarbonate levels were measured. Mean pre\u2010dialysis serum bicarbonate levels (representing 44\u00a0h post\u2010dialysis levels) in all four groups were not statistically different. Pre\u2010dialysis and 68\u00a0h post\u2010dialysis bicarbonate levels in each group were also not significantly different. However, immediate post\u2010dialysis and 2\u00a0h post\u2010dialysis bicarbonate levels were significantly increased in all four groups proportional to dialysate dose. There was statistically significant inter\u2010group bicarbonate level difference (<jats:italic>P\u00a0&lt;<\/jats:italic>\u00a00.05) except between the first and second (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.43) and second and third (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.07) groups in the immediate post\u2010dialysis period. Similar results were obtained for the 2\u00a0h post\u2010dialysis period. High bicarbonate dialysate causes large and rapid fluctuations in serum bicarbonate levels during the intra\/inter\u2010dialytic period, which returns to baseline within 44 to 68\u00a0h after dialysis. This refutes the necessity to correct pre\u2010dialysis acidosis with high bicarbonate dialysate since rapid equilibration is likely to occur and unnecessarily exposes patients to large shifts in their acid base balance.<\/jats:p>","DOI":"10.1111\/1744-9987.12510","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T15:59:57Z","timestamp":1489507197000},"page":"157-165","source":"Crossref","is-referenced-by-count":11,"title":["Changes in Serum Bicarbonate Levels Caused by Acetate\u2010Containing Bicarbonate\u2010Buffered Hemodialysis Solution: An Observational Prospective Cohort Study"],"prefix":"10.1111","volume":"21","author":[{"given":"Mandip","family":"Panesar","sequence":"first","affiliation":[{"name":"The Regional Center of Excellence for Transplantation &amp; Kidney Care at Erie County Medical Center  Buffalo New York"},{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarosh","family":"Vaqar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaushik","family":"Ivaturi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Gudleski","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine Statistics and Data Management Lab  Buffalo New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Muscarella","sequence":"additional","affiliation":[{"name":"The Regional Center of Excellence for Transplantation &amp; Kidney Care at Erie County Medical Center  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy","family":"Lambert","sequence":"additional","affiliation":[{"name":"The Regional Center of Excellence for Transplantation &amp; Kidney Care at Erie County Medical Center  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winnie","family":"Su","sequence":"additional","affiliation":[{"name":"The Regional Center of Excellence for Transplantation &amp; Kidney Care at Erie County Medical Center  Buffalo New York"},{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Murray","sequence":"additional","affiliation":[{"name":"The Regional Center of Excellence for Transplantation &amp; Kidney Care at Erie County Medical Center  Buffalo New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,3,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI112924"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/13.7.1723"},{"key":"e_1_2_8_4_1","first-page":"110","article-title":"Substitution of sodium acetate for sodium bicarbonate in the bath fluid for hemodialysis","volume":"10","author":"Mion CM","year":"1964","journal-title":"Trans Am Soc Artif Intern Organs"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1982.54"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1983.150"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(04)00936-9"},{"key":"e_1_2_8_8_1","unstructured":"FDA Safety Communication:Dialysate Concentrates and Alkali Dosing Errors with Hemodialysis. US Food and Drug Administration.http:\/\/www.fda.gov\/MedicalDevices\/Safety\/AlertsandNotices\/ucm305477.htm. 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