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Metabolic alkalosis in infants treated with peritoneal dialysis

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Abstract

Background

Acid-base balance is maintained by kidney excretion of titratable acids and bicarbonate reabsorption. Metabolic alkalosis is uncommon in dialysis-treated patients. The aim of this retrospective study was to assess the rate of metabolic alkalosis in pediatric patients treated with peritoneal dialysis.

Methods

Medical records of children treated with peritoneal dialysis in Shaare Zedek Medical Center from January 2000 to June 2021 were reviewed and compared with young adults currently treated with peritoneal dialysis. Demographic, clinical, and peritoneal dialysis characteristics were extracted from the medical records.

Results

Thirty chronic peritoneal dialysis patients were included in our study, seven under 2 years, 13 between 2 and 18 years, and 10 adults. 90.3% of the measurements in infants showed metabolic alkalosis compared to 32.3% in the 2–18-year group and none in the adult group. Higher size-adjusted daily exchange volume, lack of urine output, and high lactate-containing dialysate were associated with metabolic alkalosis. Alkalosis was not explained by vomiting, diuretic therapy, or carbonate-containing medications. High transport membrane, low dietary protein, and malnutrition, all previously reported explanations for metabolic alkalosis, were not found in our study.

Conclusions

Metabolic alkalosis is common in infants treated with peritoneal dialysis as opposed to older children and adults. High lactate-containing dialysate is a possible explanation. Higher size-adjusted daily dialysate exchange volume, which may reflect higher bicarbonate absorption, is another independent predictor of alkalosis. Acid-base status should be closely followed in infants, and using a dialysis solution with lower bicarbonate or lactate level should be considered.

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Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

Abbreviations

CKD:

Chronic kidney disease

GFR:

Glomerular filtration rate

PD:

Peritoneal dialysis

IRB:

Institutional Review Board

PET:

Peritoneal equilibration test

nPCR:

Normalized protein catabolic rate

WHO:

World Health Organization

CDC:

Centers for Disease Control and Prevention

BMI:

Body mass index

NIH:

National Institute of Health

NKF KDOQI:

National Kidney Foundation Kidney Disease Outcomes Quality Initiative

BSA:

Body surface area

SD:

Standard deviation

IQR:

Interquartile range

CAPD:

Continuous ambulatory peritoneal dialysis

APD:

Automated peritoneal dialysis

HD:

Hemodialysis

DRI:

Dietary reference intake

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel

    Shimrit Tzvi-Behr, Rachel Becker-Cohen, Choni Rinat, Jenny Weinbrand-Goichberg, Sapir Choshen, Yaacov Frishberg & Efrat Ben-Shalom

  2. Nephrology unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Alon Bnaya & Linda Shavit

  3. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Alon Bnaya, Rachel Becker-Cohen, Choni Rinat, Linda Shavit & Yaacov Frishberg

Authors
  1. Shimrit Tzvi-Behr
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  2. Alon Bnaya
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  3. Rachel Becker-Cohen
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  4. Choni Rinat
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  5. Jenny Weinbrand-Goichberg
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  6. Sapir Choshen
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  7. Linda Shavit
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  8. Yaacov Frishberg
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  9. Efrat Ben-Shalom
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Contributions

STB and EBS contributed to the study conception and design. STB, AB, and EBS performed data collection and analysis. The first draft of the manuscript was written by STB, and AB, RBC, CR, JWG, SC, LS, YF, and EBS commented on previous versions of the manuscript. All authors read and approved the final manuscript. As the corresponding author, Shimrit Tzvi-Behr confirms that the manuscript has been read and approved for submission by all the named authors.

Corresponding author

Correspondence to Shimrit Tzvi-Behr.

Ethics declarations

Ethics approval

The study was approved by the Institutional Review Board (IRB) at the Shaare Zedek Medical Center (Approval number: 0272-19-SZMC). We declare that this manuscript is original, has not been published before, and is not currently being considered for publication elsewhere.

Conflict of interest

The authors declare no competing interests.

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Tzvi-Behr, S., Bnaya, A., Becker-Cohen, R. et al. Metabolic alkalosis in infants treated with peritoneal dialysis. Pediatr Nephrol 37, 1889–1895 (2022). https://doi.org/10.1007/s00467-021-05344-w

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  • DOI: https://doi.org/10.1007/s00467-021-05344-w

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