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Bicarbonate and calcium kinetics in postdilutional hemodiafiltration
B Memoli1, R M Gazzotti, A Dello Russo
1Department of Nephrology, II Faculty of Medicine, University of Naples, Italy.
Nephron
|January 1, 1991
Summary
Hemodiafiltration (HDF) involves balancing bicarbonate and calcium. Higher ultrafiltration rates in HDF negatively impact these balances, requiring adjustments in treatment strategies for optimal patient outcomes.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Biochemistry
Background:
- Hemodiafiltration (HDF) combines dialysis and hemofiltration for efficient blood purification.
- HDF offers reduced treatment times compared to traditional dialysis.
- Understanding solute kinetics during HDF is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate bicarbonate and calcium balance across the filter during post-dilutional HDF.
- To investigate the impact of varying ultrafiltration (UF) flow rates on these balances.
- To assess the effectiveness of reinfusion in correcting solute imbalances.
Main Methods:
- Simultaneous blood sampling at filter inlet, outlet, and post-reinfusion.
- Measurement of blood pH, pCO2, TCO2, total calcium, ionized calcium, and protein.
- Calculation of plasma bicarbonate concentration from TCO2.
- Analysis of solute balance at UF rates from 12.5 to 90 ml/min.
Main Results:
- An inverse linear relationship was observed between UF flow rate and both bicarbonate (r=-0.7938) and calcium (r=-0.8731) balances.
- Negative bicarbonate balance occurred at UF rates >40 ml/min; negative calcium balance at UF rates >55 ml/min.
- Reinfusion corrected negative bicarbonate balance, but not negative calcium balance.
Conclusions:
- Post-dilutional HDF can lead to negative bicarbonate and calcium balances at higher UF rates.
- Bicarbonate balance can be managed with appropriate reinfusion solutions.
- Negative calcium balance necessitates adjustments in dialysate calcium concentration and oral supplementation.