{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:20:38Z","timestamp":1767651638866,"version":"3.40.5"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T00:00:00Z","timestamp":1671667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most hemodialysis machines deliver a fixed bicarbonate concentration. Higher concentrations may improve acidosis, but risk post\u2010hemodialysis alkalosis, whereas lower concentrations potentially increase acidosis but reduce alkalosis. We reviewed the effects of lowering dialysate bicarbonate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed peri\u2010dialysis chemistries in patients switching to a lower bicarbonate dialysate at 4 time points over 19\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We studied 126 patients, mean age 63.7\u2009\u00b1\u200916.3\u2009years, 57.9% males. Post\u2010hemodialysis alkalosis fell from 1.6 to 0.3% sessions, but pre\u2010hemodialysis acidosis increased from 11.9 to 23.8% sessions (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.005) reducing dialysate bicarbonate from 32 to 28\u2009mmol\/L. After 3\u2009months, pre\u2010hemodialysis serum bicarbonate fell (21.1\u2009\u00b1\u20092.3 to 19.8\u2009\u00b1\u20092.2\u2009mmol\/L), and post\u2010hemodialysis (24.9\u2009\u00b1\u20092.1 to 22.5\u2009\u00b1\u20092.0\u2009mmol\/L, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with a fall in pre\u2010hemodialysis weight from 74.6\u2009\u00b1\u200920.7 to 71.7\u2009\u00b1\u200918.2\u00a0kg, normalized protein nitrogen accumulation rate 0.8\u2009\u00b1\u20090.28 to 0.77\u2009\u00b1\u20090.2\u00a0g\/kg\/day, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05, and serum albumin 39.7\u2009\u00b1\u20094.2 to 37.7\u2009\u00b1\u20094.9\u00a0g\/L, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001. Thereafter, apart from pre\u2010 and post\u2010hemodialysis serum bicarbonate, weight and normalized protein nitrogen accumulation stabilized, although albumin remained lower (37.6\u2009\u00b1\u20094.0\u00a0g\/L, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). On multivariate logistic analysis, serum bicarbonate increased more with lower pre\u2010hemodialysis bicarbonate standardized coefficient <jats:italic>\u03b2<\/jats:italic> 0.5 (95% confidence interval\u2009\u22120.6 to \u22120.42), increased normalized protein nitrogen accumulation <jats:italic>\u03b2<\/jats:italic> 0.2 (0.96 to 2.38), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, and session time <jats:italic>\u03b2<\/jats:italic> 0.09, (0.47 to 5.98), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.022, and less with lower dialysate bicarbonate 0.0\u20130.23 (\u22121.54 to \u22120.74), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increases in SE\u2010Bic with hemodialysis, depend on the bicarbonate gradient, session time and nPNA. Lower D\u2010Bic reduces post\u2010hemodialysis alkalosis but increases pre\u2010hemodialysis acidosis and may initially have adverse effects on weight and normalized protein nitrogen accumulation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14483","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T14:24:45Z","timestamp":1671114285000},"page":"891-897","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of changing dialysate bicarbonate concentration on serum bicarbonate, body weight and normalized nitrogen appearance rate"],"prefix":"10.1111","volume":"47","author":[{"given":"Steven","family":"Law","sequence":"first","affiliation":[{"name":"UCL Department of Renal Medicine, Royal Free Hospital, Faculty of Medical Sciences University College London  London 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