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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.

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The relationship between dialysis dose and nutrition is a field of particular interest in chronic pediatric dialysis (PD), and a positive correlation between ureaKt/V and nPNA has been published, suggesting a better nutritional status is associated with higher dialysis doses. However, this relationship has also been criticized as being the result of a mathematical coupling resulting from the same variables. The objective of the study was to establish the relationship between dialysis dose (Kt/V) and nutritional variables: daily protein intake (DPI), protein catabolic rate (PCR), protein equivalent of total nitrogen appearance (PNA) and nitrogen balance (NB) in dialyzed children. A cohort, prospective, observational study was carried out, for which 223 biochemical measurements were performed in 20 patients, ages 1 month to 14.3 years old (13 males), under PD for a 12-month period of follow-up. Monthly residual and total ureaKt/V, DPI, PCR, nPNA and NB were calculated, and the correlation between Kt/V and the nutritional parameters was evaluated. The Borah equation was used to calculate the nPNA. The data are reported as the mean plus or minus the standard error. All statistical comparisons were done with a paired t test, and two-way ANOVA for repeated measures was used to calculate correlations. A P <0.05 was considered significant. Mean total and residual Kt/V was 3.4+/-1.3 and 1.69+/-1.27, respectively; nPNA and PCR were 1.38+/-0.44 and 1.39+/-0.43 g/kg/day, daily protein intake (DPI) was 3.25+/-1.27 g/kg/day, and NB showed a value of 1.86+/-1.25 g/kg/day. A significant positive correlation was found between Kt/V and DPI, PCR, DPC and nPNA (all values P <0.0001), but no correlation was found between total and residual Kt/V vs. nitrogen balance ( P:ns). Total Kt/V showed a significant positive correlation with nPNA, but it did not show any correlation with nitrogen balance, suggesting that the relationship with nPNA is the result of a mathematical association calculated from the same variables.

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