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Nephrol Ther. 2018 Feb;14(1):13-23. doi: 10.1016/j.nephro.2017.02.014. Epub 2017 Nov 15.

[Bicarbonate: From physiology to treatment for all clinicians].

[Article in French]

Author information

1
Service de dialyse, HIA Sainte-Anne, boulevard Sainte-Anne, 83000 Toulon, France; Club des jeunes néphrologues, 2, rue du Bourg-l'Abbé, 75003 Paris, France.
2
Club des jeunes néphrologues, 2, rue du Bourg-l'Abbé, 75003 Paris, France; Service de néphrologie, hémodialyse, transplantation, hôpital Maison-Blanche, CHU de Reims, avenue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université Reims-Champagne-Ardenne, 51000 Reims, France.
3
Club des jeunes néphrologues, 2, rue du Bourg-l'Abbé, 75003 Paris, France; Unité d'hémodialyse de Saint-Malo, AUB santé, 1, rue de la Marne, 35400 Saint-Malo, France.
4
Club des jeunes néphrologues, 2, rue du Bourg-l'Abbé, 75003 Paris, France; Explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France. Electronic address: jean-philippe.bertocchio@aphp.fr.

Abstract

Acid-base regulation is essential to maintain homeostasis in humans. Carbonic acid/bicarbonate (H2CO3/HCO3-) couple is the most predominant extracellular buffer to keep plasma pH within a physiological range. The ability to (re)generate such a buffer is a key milestone that necessitates to understand a precise physiology of both renal tubule and digestive tract. Here, we first reviewed renal and digestive cycles of bicarbonate in physiology. We also reviewed pathological findings where acid-base disequilibrium is involved and nutritional and/or alkali therapy could be necessary. Secondly, data from clinical trials were synthesized. Alkali therapy, oral and parenteral, from mineral-based water, masterful preparations or pharmaceutics drugs, is regularly used in a wide range of clinical findings, even if supporting data are (often) of a low level of evidence. Bicarbonate is primarily used during contrast-induced nephropathy, metabolic acidosis in chronic kidney disease or nephrolithiasis in which alkaline urine is necessary. Cast nephropathy, rhabdomyolysis and tumor lysis syndrome make usually physicians prescribe alkali therapy even if this prescription is only supported by physiopathological data without any proven clinical results. Finally, bicarbonate is essential in the composition of dialysate in both hemodialysis and peritoneal dialysis.

KEYWORDS:

Bicarbonates; Dialysis solutions; Hydrogénocarbonates; Insuffisance rénale chronique; Physiologie; Physiology; Renal insufficiency chronic; Solutions de dialyse; Urolithiase; Urolithiasis

PMID:
29150416
DOI:
10.1016/j.nephro.2017.02.014
[Indexed for MEDLINE]

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