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Inter-Dialytic Acidosis — ESENeph MCQ

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ModerateAcid-BaseInter-Dialytic AcidosisESENeph

A 60-year-old man on haemodialysis has persistent acidosis (pre-dialysis bicarbonate 16 mmol/L) despite adequate dialysis (spKt/V 1.4). Dialysate bicarbonate is 32 mmol/L. What intervention may help correct his inter-dialytic acidosis?

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Correct answer: C — Oral sodium bicarbonate supplementation between dialysis sessions

Persistent inter-dialytic metabolic acidosis is common in haemodialysis patients. While dialysis corrects acidosis during the session, bicarbonate falls between sessions due to metabolic acid generation. Oral sodium bicarbonate supplementation between dialysis sessions can help maintain bicarbonate levels. Increasing dialysate bicarbonate is an option but may cause alkalosis during dialysis. KDIGO 2024 and ERA-EDTA guidelines support targeting bicarbonate ≥22 mmol/L. Severe protein restriction is not recommended in dialysis patients.

Reference: ERA-EDTA 2018 – Acid-Base in HD; KDIGO 2024 CKD (Practice Point 3.10)