Acetate versus bicarbonate hemodialysis in critically ill patients

The hemodynamic state, acid-base balance and blood gases were studied in 9 acute renal failure patients during recirculation acetate- and bicarbonate dialysis. A significant hemodynamic instability, due to a decreased cardiac performance, was observed during acetate dialysis, whereas during bicarbonate dialysis, there was a stable hemodynamic state. During acetate dialysis, pO2 dropped significantly, due to a decreasing ventilatory drive as a consequence of the significantly lower pCO2 in acetate dialysis. From these findings, we conclude that bicarbonate dialysis should be the first choice in the treatment of acute renal failure patients.