[Improvement of tolerance of dialysis sessions using bicarbonate baths. Results of a controlled study]

Benefits of using bicarbonate (B) containing dialysates instead of acetate (A) dialysates is still controversial. A single blind study was therefore performed using patients as their own control. Thirteen males and 10 females (mean age 44 years), with a poor dialysis tolerance were included in the study. 14 patients were dialyzed one week with dialysate A (A 38 mmol/l, CO3H 0, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5) and then one week with dialysate B (A 9, CO3H 29, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5); 9 patients were dialyzed one week with B and then one week with A. Measured osmolarity was 302 mOsm/l for dialysate A and 291 for dialysate B. A Unimat dialysate generator from Bellco was used in both cases. Student paired t tests were used for comparisons. Predialysis mean values of body weight, systolic and diastolic blood pressures, serum Na, K, Ca, P, BUN, and creatinin did not differed significantly with A and B dialysates. Hypotensive episodes (19.6% vs 36.2% p less than 0.05), headaches (5.8% vs 14.5%, p less than 0.05), and vomiting (8.0% vs 18.5%, p less than 0.10) were less frequent with B than with A. Postdialysis blood CO3H, K and P were higher with B than with A (all p less than 0.05). Results confirm, in acute conditions, the better tolerance of bicarbonate dialysis comparatively to acetate dialysis.