Alkalemia during continuous renal replacement therapy and mortality in critically ill patients

Crit Care Med. 2008 May;36(5):1513-7. doi: 10.1097/CCM.0b013e318170a2f5.


Objective: Acid-base disorders are common in critically ill patients. Once continuous renal replacement therapy (CRRT) is initiated, it becomes a major determinant of acid-base status. We hypothesized that therapy-induced alkalemia and alkalosis is associated with increased mortality.

Patients: The CCF-ARF Registry (1995-01) was used to identify 405 patients supported with bicarbonate based continuous hemodialysis. Proportion of days with an elevated pH to the number of days with normal pH was used to assess the association of alkalemia and the number of days with alkalemia, and mortality. Multivariable analyses were used to adjust for days with acidosis, and other relevant covariates.

Main results: Serum bicarbonate and pH levels plateau after 48 hrs of CRRT. Study subjects had on average 1.5 +/- 2.9 days where pH was greater than 7.45, and .4 days where serum bicarbonate level was greater than 28 mmol/L, during a median of 9 days of CRRT. Daily dialysis dose was inversely associated with the number of days with a low serum bicarbonate level, but was not associated with increased frequency of an elevated pH or serum bicarbonate level. Increasing proportion of days with elevated pH or serum bicarbonate was not associated with increased mortality in multivariable analysis.

Conclusions: Alkalemia and alkalosis occur frequently during CRRT, but they are not associated with increased mortality. Persistent acidosis and acidemia while on CRRT was a strong predictor of poor outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / complications
  • Acute Kidney Injury / mortality*
  • Acute Kidney Injury / therapy*
  • Alkalosis / blood*
  • Alkalosis / etiology*
  • Critical Illness
  • Female
  • Humans
  • Male
  • Middle Aged
  • Renal Replacement Therapy / adverse effects*