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Haemodialysis-induced respiratory changes.

S Fawcett, N A Hoenich, M F Laker

    Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    |January 1, 1987
    PubMed
    Summary
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    Using bicarbonate dialysate with biocompatible membranes improves haemodialysis oxygen levels and reduces adverse effects like hypoventilation and leucopenia, optimizing patient treatment.

    Area of Science:

    • Nephrology
    • Physiology
    • Biomaterials Science

    Background:

    • Haemodialysis can cause hypoxaemia and leucopenia.
    • Acetate dialysate is associated with hypoventilation and reduced CO2 excretion.

    Purpose of the Study:

    • To compare the effects of different dialysis membranes (Cuprophan, PAN 15) and dialysate buffers (acetate, bicarbonate) on physiological parameters in haemodialysis patients.
    • To identify optimal dialysis protocols for minimizing adverse effects.

    Main Methods:

    • Eight maintenance haemodialysis patients were studied.
    • Six dialysis protocols were used, varying membrane type and dialysate buffer.
    • Measurements included arterial oxygen (PaO2), serum acetate, WBC count, transfer factor (DLCO), and respiratory exchange ratio.

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    Main Results:

    • Cuprophan membranes and acetate dialysate caused significant hypoxaemia and leucopenia.
    • Polyacrylonitrile (PAN 15) membranes reduced hypoxaemia and leucopenia compared to Cuprophan.
    • Bicarbonate buffer mitigated hypoxaemia but did not eliminate it; it also prevented acetate-induced hypoventilation.

    Conclusions:

    • Bicarbonate dialysate and biocompatible membranes (PAN 15) improve haemodialysis outcomes.
    • Hypoxaemia is multifactorial, involving hypoventilation and leucostasis.
    • Optimal treatment involves biocompatible membranes and bicarbonate-buffered dialysate, especially for patients with cardiovascular compromise.