ABSTRACT
The spectrum of acid-base disorders that can occur in patients receiving renal replacement therapy is narrower and in some ways unique, compared to patients with functioning kidneys (1,2). In the absence of kidney function, one need not consider acid-base disorders induced by changes in renal electrolyte and acid excretion. For the same reason, exogenous alkali administration can induce sustained metabolic alkalosis in these patients. The general approach to identifying acid-base disorders in dialysis patients, nonetheless, is the same as in patients with functioning kidneys (see Chapter 28). The clinician must identify the primary disorder (e.g., metabolic acidosis or alkalosis, respiratory acidosis or alkalosis), determine whether the secondary response is appropriate, assess the anion gap, and determine the cause.
