Observational analysis reveals a U-shaped mortality risk for predialysis bicarbonate levels in hemodialysis patients, suggesting vascular access type biases guideline targets.
Considerable debate exists about the optimal treatment of metabolic acidosis in hemodialysis patients,1,S1,S2 and interventional studies evaluating the effect of different target predialysis bicarbonate levels on outcomes are lacking. Observational studies have found somewhat conflicting results regarding the correlation of predialysis bicarbonate levels with cardiovascular and all-cause mortality but mostly pointed to a U-shaped relationship after adjustment for confounding factors.2–6 On the basis of these observational studies, guidelines have formulated target predialysis serum bicarbonate levels.
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Bock et al. (2022) studied this question.
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