Bicarbonate Hemodialysis: Influence on Plasma Refilling and Hemodynamic Stability

Hsu, Chen H.; Swartz, Richard D.; Somermeyer, Michael G.; Raj, A. Clement Louis

doi:10.1159/000183308

Cited by 38 publications

(10 citation statements)

References 17 publications

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“…The most important difference to ourstudy is the fact that Borgeset al [5] were infusing routinely mannitol during the first 4 dialyses. As demonstrated by the study of H suet al [15], this could rule out the influence of the difference in plasma refilling during acetate and bicarbonate dialysis. Blood gas analysis and acid-base balance measurements were only done 2 and 4 h after starting dialysis.…”

Section: Discussionmentioning

confidence: 90%

Acetate versus Bicarbonate Hemodialysis in Critically Ill Patients

Leunissen

Hoorntje

et al. 1986

Nephron

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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.

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Section: Discussionmentioning

confidence: 90%

Acetate versus Bicarbonate Hemodialysis in Critically Ill Patients

Leunissen

Hoorntje

et al. 1986

Nephron

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“…Since 1980, in the most cases, bicarbonate has been substituted for acetate in the dialysis in order to improve the hemody namic stability during hemodialysis [24,25], Peritoneal dialysis, which is hemodynamically less stressful for pa tients, has been performed in a few elderly patients with noncatabolic renal failure during the years 1975-79 [26]. In the last years, intermittent [27,28] and continuous hemofiltration [29,30] have been more commonly used in the therapy of ARF.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Prognosis of Patients with Acute Renal Failure over a Period of 15 Years: An Analysis of 710 Cases in a Dialysis Center

Biesenbach¹,

Zazgórnik²,

Kaiser³

et al. 1992

Am J Nephrol

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In order to evaluate the changes in causes and outcome of acute renal failure (ARF) during the years 1975-1989, 710 patients treated in our dialysis center were analyzed. We compared the etiology, the severity and catabolic state of ARF, the techniques of renal replacement therapy, which were employed and the ages and mortality rates of these patients, who received dialysis therapy during the years 1975-79 (n = 227), 1980-84 (n = 240) and 1985-89 (n = 243). The number of postoperative, posttraumatic and non-traumatic cases of ARF was approximately the same in all three 5-year periods, only the frequency of postrenal failure decreased from 7% in the years 1975-79 to 3% in the years 1985-89. The incidence of sepsis as a major cause of ARF and the most important risk factor was comparably high in the surgical and medical patients during all of the periods, but it increased in the traumatic patients from 7 % in the years 1975-79 to 28 % during the last 5-year period. The prevalence of respiratory failure and jaundice as additional organ failures, the severity of ARF (oligonanuric-nonoliguric) and the metabolic state were not different in the three patient groups. The magnitude of rise in serum creatinine before the start of renal replacement therapy was significant lower in the last 5-year period in comparison to the years 1975-79 (p < 0.05). Hemodialysis was the treatment in choice of 98 and 93 % of the cases during the first two periods, respectively. Since 1980, bicarbonate was employed in the dialysis instead of acetate in the most cases. In the years 1985-89, hemodialysis was only performed in 51 % of the patients, intermittent or continuous hemofiltration was used in 49%. The mortality of all the patients was reduced from 69% in the years 1975-79 to 54 and 48%, respectively, in the last two 5-year periods (p < 0.01), though the mean age of the patients has increased from 44 (9-84) to 57 (10-84) and 58 years (15-90), respectively. This improvement in outcome has been demonstrated in surgical and traumatic as well as nontraumatic and postrenal failure.

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“…Acetate impairs PVP at the capillary level by inducing arteriolar vasodilation, thus increasing the in tracapillary hydrostatic pressure. In this re spect, bicarbonate is more favorable, especial ly in patients with a compromised left ventric ular function [19,20],…”

Section: Pathophysiologymentioning

confidence: 99%