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Introduction-Aim: Uncorrected metabolic acidosis leads to higher death risk in dialysis patients. We observed the relationship
between metabolic acidosis status and mortality rate in patients on renal replacement therapy during a median follow up time
of 60 months.
Methods: We studied 76 patients on on-line hemodiafiltration. Dialysis adequacy was defined by Kt/V for urea. Framingham
risk score (FRS) points were used to determine the 10-year risk for coronary heart disease. We examined the impact of high or
low serum bicarbonate concentrations on mortality rate and on 10-year risk for coronary heart disease via the Kaplan-Meier
method. Cox’s model was used to evaluate a combination of prognostic variables, such as dialysis adequacy defined by Kt/V for
urea, age and serum bicarbonate concentrations.
Results: We divided the enrolled patients in 3 groups according to serum bicarbonate concentrations (<20 mmol/L, 20-
22 mmol/L and >22 mmol/L). Kaplan-Meier survival curve for the impact of serum bicarbonate concentrations on overall
mortality was found significant (log-rank=7.8, p=0.02). The prevalence of serum bicarbonate less or more than 20 mmol/L on
high FRS ( >20%) by Kaplan-Meier curve was also found significant (log-rank=4.9, p=0.02). Cox’s model revealed significant
predictive effect of serum bicarbonate on overall mortality (p=0.006, OR=1.5, 95% CI=1.12-1.98) in combination to Kt/V for
urea and age.
Conclusion: Uncorrected severe metabolic acidosis, defined by serum bicarbonate concentrations less than 20 mmol/L,
is associated with 10-year risk for coronary heart disease more than 20% and high overall mortality in patients on renal