Alkalemia associated with renal failure. Correction by hemodialysis with low-bicarbonate dialysate

Hemodialysis with a low-bicarbonate dialysate was used in four patients for the simultaneous treatment of acute renal failure and fluid overload associated with alkalemia. All patients had a mixed acid-base disorder, namely respiratory alkalosis superimposed on metabolic alkalosis. Correction of alkalemia and azotemia was accomplished with low-bicarbonate dialysis without signs of hemodynamic deterioration. This successful experience, coupled with the reported side effects of acetate-containing dialysate, would suggest the use of a low-bicarbonate dialysate as a recommended therapy of renal failure associated with alkalemia.