Acetate-induced myocardial depression during hemodialysis for acute renal failure

Abstract

We studied the cardiovascular effects of hemodialysis in five critically ill patients with ultrafiltration using, alternately, bicarbonate and acetate in the dialysate. After 3 hr of dialysis with acetate, significant decreases in both arterial pressure and stroke volume resulted in lowered left ventricular stroke work (P less than 0.025). This effect persisted 30 min after the end of the dialysis (P less than 0.025). Differences in the patients' cardiac preload were ruled out by similar pulmonary artery balloon-occluded pressures during both types of dialysis. These observations suggest that dialysis with acetate can result in myocardial depression. The use of bicarbonate dialysate is thus advisable for acute hemodialysis in critically ill patients.

Effects of Uremia, Acetate and Bicarbonate Dialysis on Beta-Adrenergic Responsiveness as Assessed by Epinephrine-Stimulated Adenylate Cyclase

“…One possibility is that a reduction of P-adrenergic responsiveness induces myocardial depression, causing a failure of cardiac out put to increase in response to intradialytic hemodynamic stresses: in fact decreased myocardial contractility was observed after the infusion of acetate in dogs and in humans [17,18] and after acetate dialysis but not after bicarbonate dialysis in patients with acute renal failure in two different series [19,20], However, the conflicting results obtained by other authors [21 -24] do not confirm this hypothesis.…”

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

“…Sodium acetate has fallen into disuse as a dialysate buffer due to adverse events associated with its administration, including myocardial depression, hypotension, and hypopnea resulting in hypoxemia [22][23][24]. Sodium acetate, when given in excess during dialysis, is funneled to alternative metabolic pathways, leading to increased nitric oxide concentrations and resulting hemodynamic instability [25].…”

Hemofiltration in Multiorgan Failure Syndrome Secondary to Sepsis: A Critical Analysis of Heterogeneity

“…The buffer of the hemodialysis solution was changed to bicarbonate, because of the well-known negative effects of acetate upon cardiac performance and arteriolar tone, already compro mised in the critically ill patient [47,48]. Hospital mortal ity observed in this study was 38% for the surgical group and 35% for the nonsurgical one.…”