Acetate versus Bicarbonate Hemodialysis in Critically Ill Patients

Abstract

The hemodynamic state, acid-base balance and blood gases were studied in 9 acute renal failure patients during recirculation acetate- and bicarbonate dialysis. A significant hemodynamic instability, due to a decreased cardiac performance, was observed during acetate dialysis, whereas during bicarbonate dialysis, there was a stable hemodynamic state. During acetate dialysis, pO₂ dropped significantly, due to a decreasing ventilatory drive as a consequence of the significantly lower pCO₂ in acetate dialysis. From these findings, we conclude that bicarbonate dialysis should be the first choice in the treatment of acute renal failure patients.

Ionized Calcium Plays a Pivotal Role in Controlling Blood Pressure during Haemodialysis

“…It has been claimed that especially the linear cor rection of the acidosis during recirculation Bc-D will result in a more stable cardiovas cular state [1], However, Henrich et al [8] found that increase in plasma bicarbonate, achieved in 1 dialysis treatment, did not appear to change ventricular contractility in stable dialysis patients. He concluded that the increase in plasma ionized calcium was the most important factor for improving left ventricular contractility and not the correc tion of acidaemia.…”

Blood Purification Procedures for Acute Renal Failure: Convenient Strategy Related to Clinical Conditions

“…In particular, in patients with MOF, in whom the hemodynamic conditions are usually compromised, a good dialytic tolerability is to be preferred to the dialytic efficacy. An im provement of the intradialytic symptomatolo gy was obtained by giving up the use of acetate HD, recognized as a relevant cofactor in the generation of cardiovascular instability [4], It is widely accepted that even a membrane bio incompatibility has an important role in de termining cardiovascular instability [14]. Anyway, a biocompatible membrane (poly acrylonitrile) has been used in all our cases, and in the four techniques used a good tolera bility was observed.…”

“…In 141 patients suffering from ARF, including 76 patients with associated MOF, four different hemodialysis techniques were used: standard bicarbonate (HCO5) HD [4], acetate-free biofiltration (AFB) [5], continuous arteriovenous hemofil tration (CAVH) [6], and daily recycled HCO3 HD (daily HD) [7],…”

Hemodynamic Stability during Different Forms of Dialysis Therapy: A Pathogenetic Analysis

“…68-71] that tolerance to ultrafiltration is bet ter with bicarbonate, especially in patients who are prone to developing symptomatic hy potension or when dialvsate sodium concen trations of about 130 mmol/1 are used. Im paired hemodynamic stability with acetatebuffered dialvsate is mainly related to the vasodilative capacity of acetate together with the individual capacity to metabolize acetate [72], In addition, an impairment in cardiac performance can also contribute to hemody namic stability in acetate dialysis [73], Most probably, the decrease in total peripheral re sistance during UF+HD, as has been reported by several authors, is explained by the use of acetate. Baldamus et al [36] found that only in acetate-buffered UF+HD.…”