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Buffer kinetics in biofiltration.

M Feriani, L Bragantini, R Dell'Aquila

    The International Journal of Artificial Organs
    |December 1, 1986
    PubMed
    Summary
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    Patients undergoing biofiltration (BF) experienced metabolic alkalosis due to excessive buffer gain. Reducing acetate in dialysate is recommended to prevent dangerous plasma acetate levels.

    Area of Science:

    • Nephrology
    • Biochemistry

    Background:

    • Metabolic alkalosis is a common complication in patients undergoing regular biofiltration (BF).
    • Understanding buffer kinetics is crucial for managing acid-base balance during dialysis.

    Purpose of the Study:

    • To assess buffer kinetics, including bicarbonate (HCO3) and acetate (CH3COO) exchange, during a standard biofiltration session.
    • To evaluate the net buffer gain and its implications for patients undergoing chronic biofiltration.

    Main Methods:

    • Five patients on regular biofiltration for 10 months were studied during a dialysis session.
    • Measurements included dialysate composition (38 mEq/L acetate), replacement fluid (1000 ml/h with 100 mEq/L HCO3), and blood parameters.
    • Dialyzer specifications (Biospal 3000S, Qb 301; Qd 545; UF 36.76 ml/min) were recorded.

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    Main Results:

    • Significant bicarbonate losses (756 +/- 112 mEq) and acetate uptakes (677 +/- 152 mEq) were observed.
    • Plasma acetate levels increased to a potentially dangerous 10.4 mEq/L.
    • The net dialytic buffer gain was high (230 +/- 137 mEq/dialysis), exceeding patient requirements.

    Conclusions:

    • Current biofiltration protocols result in excessive buffer gain and high plasma acetate levels.
    • Reducing acetate concentration in dialysate is preferable to lowering bicarbonate infusion to mitigate risks.
    • Optimizing dialysate composition is essential for safe and effective biofiltration therapy.