[Plasma acetate and bicarbonate kinetics and intolerance to acetate during and after renal dialysis]

Plasma acetate kinetics, acid-base homeostasis and clinical tolerance were monitored in 7 patients with chronic renal failure during and after hemodialysis with standard conditions. In 6 patients, without severe clinical symptoms acetate levels became stable during the last hour of dialysis (4.86 +/- 0.44 mmol/l) and decreased according to first order kinetics (half-life (8.82 +/- 3.42 mn). Simultaneously bicarbonate levels significantly increased (p less than 0.005). At the opposite the 7th patient has been characterised by a continuous rise in acetate levels (12.3 mmol/l at the end of the dialysis), a slower elimination (half-life: 31.0 mn), a collapse of plasma bicarbonate and severe acetate intolerance. Moreover symptomatic patients were characterised by an increase of plasma levels and half-lives. Therefore it seems that during dialysis of comparable efficiency, an insufficient rate of acetate metabolism may be at the origin of a worsening of metabolic acidosis as well as an increase of acetate load, responsible for severe acetate intolerance.