Disturbances in Acid-Base Balance in Patients on Hemodialysis

The prevalence of metabolic acidosis increases in Chronic Kidney Disease (CKD) patients ac‐ cording to the fall in glomerular filtration rate (GFR). In early stages of renal dysfunction acid retention is mainly due to the reduced tubular ammonium (NH4+) secretion. As GFR de‐ clines retention of organic acids (HSO4, HPO4) is also observed. The acid load resultant from diet and protein catabolism was believed to be the main responsible for acidosis in he‐ modialysis patients, however recent studies have shown an increasingly important role of hyperchloremia in the genesis of metabolic acidosis and pathophysiological disorders asso‐ ciated with it [1]. This finding was made possible through the use of Stewart ́s [2] physico‐ chemical approach for diagnosis and classification of acid base disorders. This new approach not only enables the identification and classification of acid-base disorders and al‐ lows the quantification of the magnitude of each component to the disorder genesis [3,4].