Kidney Function

The American Journal of Kidney Diseases Acid-Base and Electrolyte Teaching Case from Saito et al, which appeared in a recent issue of the journal, presents a teaching opportunity about research designs and in particular the use of single-subject (N-of-1 or N=1) trials. Saito et al observed instability in a patient with congenital methylmalonic acidemia during hemodialysis (HD) using an acetate-containing dialysate. Based on biochemistry, they assumed that this response likely was caused by the acetate. They tested an acetate-free citrate HD dialysate in the same patient and did not find this response. Their study looked to more rigorously compare the effectiveness of these 2 buffers and also to verify the connection between the observed adverse reactions (hypotension) and the acetate-based dialysate in this individual.