Desempeño analítico de los métodos de control de calidad de una solución concentrada para hemodiálisis / Analytical performance of the quality control methods in a concentrated solution for hemodialysis

Objetivo: evaluar el desempeño de los métodos de cuantificación de los iones sodio, potasio, cloruro, calcio y magnesio en una solución concentrada para hemodiálisis con bicarbonato. Métodos: los cinco métodos aparecen informados en la farmacopea británica. Para la verificación del desempeño, se utilizaron los parámetros, linealidad, exactitud y precisión. Se empleó el método de placebo enriquecido utilizando niveles de 60 a 140 por ciento de la concentración nominal de cada ion. Resultados: los cinco métodos resultaron lineales en el intervalo de concentraciones evaluadas, fueron precisos y exactos, con coeficientes de variación global menor que 1,75 por ciento, y una recuperación entre 100 ± 3 por ciento. Conclusiones: los métodos de cuantificación de los iones presentes en la solución concentrada para hemodiálisis con bicarbonato, permiten obtener resultados fiables en las condiciones analíticas practicadas en esta investigación(AU)

Objective: to evaluate the analytical performance of the sodium, potassium, chloride, calcium and magnesium ions quantification methods, in a concentrated solution with bicarbonate for hemodyalisis. Methods: the five analytical methods are reported on the official British pharmacopeia. The performance evaluation was made by verifying linearity, accuracy and precision. In all cases, the enriched placebo method was used, with concentration levels from 60 to 140 percent of the standard concentration value of each ion. Results: the five methods showed linearity in the evaluated concentration range; they were accurate and precise with global variation coefficients lower than 1.75 percent, and a recovery rate of 100 ± 3 percent. Conclusions: the quantification methods for the ions present in concentrated solution with bicarbonate for hemodialysis, allows obtaining reliable results under the analytical conditions used in this research(AU)

Efeito benéfico da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise / Beneficial effects of metabolic acidosis correction in hemodialysis patients

Objetivo: Avaliar o efeito da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise. Métodos: Foram estudados, durante seis meses, 20 pacientes com acidose metabólica, definida pela média de tr~es mensurações de bicarbonato sérico pré-diálise <22 mEq/L. os pacientes dialisavam há, pelo menos, seis meses, utilizando bicarbonato de 35 mEq/L no dialisato. A correção da acidose metabólica foi feita mediante elevação do bicarbonato no dialisato para valores que não ultrapassaram 40 mEq/L, objetivando um bicarbonato sérico entre 22-26 mEq/L. Foram avaliados no início e no final do estudo: avaliação antropométrica, dietética, bioquímica e Avaliação subjetiva Global (ASG). Resultados: A avaliação nutricional na fase inicial do estudo demonstrou índice de massa corporal normal (24,23 +- 3,83 Kg/m²). A circunferência muscular do braço, a prega cutânea tricipital e a ASG classificaram homens e mulheres como desnutridos. Os consumos de calorias e proteínas foram 29,7 +- 10,1 Kcal?kg/dia e 1,31 +- 0,35 g/Kg/dia, respectivamente. A avaliação bioquímica observou albumina sérica normal e colesterol reduzido. Após correção, bicarbonato sérico e pH aumentaram de 18,2 +- 1,64 para 22 +- 1,70 (p<0,001), e de 7,32+- 0,45 para 7,37 +-0,41 (p<0,001), respectivamente. Houve melhora da ASG (21,7 +- 6,4 versus 16,8 +-6,6, p<0,0001) e aumento na ingestão calórica (1.892,61 +-454,30 versus 2.110,30 +-869,24, p<0,05). Conclusão: A suplementação de bicarbonato na solução de hemodiálise foi método efetivo para a correção da acidose metabólica, determinando aumento da ingestão calórica e melhora nos escores da ASG.

Objective: To evaluate the effect of correction of metabolic acidosis on nutritional status of hemodialysis patients. Methods: We studied for six months, 20 patients with metabolic acidosis, defined as the average of tr ~ s measurements of predialysis serum bicarbonate <22 mEq / L. patients receiving dialysis treatment for at least six months, using bicarbonate of 35 mEq / L in the dialysate. The correction of metabolic acidosis was observed in the high bicarbonate dialysate for values that exceeded 40 mEq / L, aiming for a serum bicarbonate between 22-26 mEq / L. Were assessed at baseline and at the end of the study: anthropometric, dietary, biochemical and Subjective Global Assessment (SGA). Results: The nutritional assessment in the initial phase of the study showed normal BMI (24.23 + - 3.83 kg / m²). The arm muscle circumference, triceps skinfold and the ASG men and women classified as malnourished. The intake of calories and protein were 29.7 + - 10.1 Kcal? Kg / day and 1.31 + - 0.35 g / kg / day, respectively. The biochemical evaluation showed normal serum albumin and low cholesterol. After correction, serum bicarbonate and pH increased from 18.2 + - 1.64 for 22 + - 1.70 (p <0.001), and 7.32 + - 0.45 to 7.37 + -0.41 ( p <0.001), respectively. There was improvement in ASG (21.7 + - 6.4 versus 16.8 + -6.6, p <0.0001) and increased caloric intake (1892.61 + -454.30 vs 2110.30 + -869 , 24, p <0.05). Conclusion: Supplementation of bicarbonate in the dialysis solution was an effective method for correction of metabolic acidosis, determining increased caloric intake and improvement in the scores of the ASG.

Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution.

Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group), received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020). When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069), but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001).