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Hypoxemia during hemodialysis using acetate versus bicarbonate dialysate
American Journal of Nephrology
|January 1, 1984
Summary
Bicarbonate dialysate does not prevent hypoxemia during hemodialysis. Both acetate and bicarbonate dialysates cause a drop in oxygen levels, linked to changes in ventilation and white blood cell counts.
Area of Science:
- Nephrology
- Pulmonary Physiology
- Critical Care Medicine
Background:
- Dialysis-related hypoxemia is a common complication.
- The precise causes and extent of hypoxemia during hemodialysis remain incompletely understood.
Purpose of the Study:
- To investigate the extent and underlying causes of dialysis-related hypoxemia.
- To compare the effects of acetate (AC) and bicarbonate (HCO3) dialysate on oxygen levels during hemodialysis.
Main Methods:
- Studied 10 patients undergoing hemodialysis with AC and HCO3 dialysates on separate occasions.
- Measured arterial blood gases, white blood cell (WBC) count, minute ventilation (VE), and inspired/expired gas concentrations.
- Calculated respiratory quotient (R) and alveolar-arterial oxygen difference ((A-a)DO2) before and during dialysis.
Main Results:
- 8 out of 10 patients developed hypoxemia with both dialysate types.
- Arterial oxygen partial pressure (PaO2) decreased significantly at 30 minutes with both AC and HCO3.
- Increased (A-a)DO2 correlated with PaO2 drop; fall in PaO2 correlated with fall in WBC count.
- HCO3 resulted in a greater increase in arterial pH compared to AC, coinciding with decreased VE.
Conclusions:
- Bicarbonate dialysate does not prevent hypoxemia during hemodialysis.
- Hypoxemia is multifactorial, involving hypoventilation, ventilation/perfusion (V/Q) abnormalities, and increased arterial pH, influenced by dialysate type and dialysis timing.