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Optimal dialysate bicarbonate during hemodialysis.
1Department of Medicine, University of Pittsburgh, Pennsylvania.
ASAIO Transactions
|July 1, 1991
Summary
Acetate and low-concentration bicarbonate dialysate inadequately control acid-base balance in hemodialysis patients. Higher bicarbonate concentrations improve acid-base control but may cause alkalosis and hypoxemia.
Area of Science:
- Nephrology
- Biochemistry
Background:
- Maintaining acid-base balance is crucial for hemodialysis patients.
- Acetate and bicarbonate dialysates are used to manage metabolic acidosis.
Purpose of the Study:
- To evaluate the efficacy of different bicarbonate dialysate concentrations in controlling acid-base balance during hemodialysis.
Main Methods:
- Eleven hemodialysis patients were studied.
- Dialysate composition (acetate vs. bicarbonate at varying concentrations) was altered.
- Blood samples were analyzed for pH, PCO2, bicarbonate, and PO2 before and after dialysis.
Main Results:
- Acetate (35 mEq/L) and 25 mEq/L bicarbonate dialysate failed to adequately control acid-base balance.
- 30 mEq/L bicarbonate showed mild predialysis acidosis.
- 35 mEq/L bicarbonate corrected acidosis but led to postdialysis alkalosis and mild hypoxemia.
Conclusions:
- Bicarbonate dialysate concentration is critical for effective acid-base management in hemodialysis.
- Optimal bicarbonate concentration requires balancing acidosis correction with preventing alkalosis and hypoxemia.