Osmolar Changes during Dialysis

Cm, Kjellstrand

doi:10.1177/039139888000300501

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…It has been demonstrated previously [10,14] that high sodium dialysate can promote greater fluid mobilization from the extravascular compartments, thereby reconstituting a greater portion of the plasma volume lost during ultrafiltration. This latter observation is confirmed in the present study, and may partially explain the lower incidence of hypotension during high osmolality dialysis [16][17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 86%

Bicarbonate Hemodialysis: Influence on Plasma Refilling and Hemodynamic Stability

Hsu¹,

Swartz²,

Somermeyer³

et al. 1984

Nephron

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The present study compares the effect of sodium bicarbonate (LoNaHCO₃, Na = 134, HCO₃ = 33 mEq/l) and sodium acetate (LoNaAc, Na =134, acetate 33 mEq/l) dialysate on the extravascular fluid mobilization (V_FM) and hemodynamic changes in 6 patients during 3 h of hemodialysis with equivalent fluid ultrafiltration of about 600 ml/h. The cumulative decrease in plasma volume after 1, 2 and 3 h of dialysis was significantly less during LoNaHC0₃dialysis than during LoNaAc dialysis, with plasma volume almost completely refilled by V_FM during the first 2 h of LoNaHCO₃ dialysis. High sodium acetate dialysate (HiNaAc, Na = 144, acetate = 33 mEq/l) with equivalent fluid ultrafiltration also resulted in less net decrease in plasma volume and greater V_FM than LoNaAc, although the temporal pattern of refilling was somewhat different from that during LoNaHCO₃: rapid and complete refilling during the early portion of LoNaHCO₃, slower and more progressive refilling during HiNaAc, with similar cumulative refilling for LoNaHCO₃ and HiNaAc by 3 h. Mean arterial pressure (MAP) tended to decrease during LoNaAc dialysis, whereas MAP remained stable during LoNaHCO₃ and increased slightly during HiNaAc. This study, therefore, suggests that improved hemodynamic stability utilizing bicarbonate dialysate may be due, in part, to greater plasma refilling and better preservation of plasma volume.

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Section: Discussionsupporting

confidence: 86%

Bicarbonate Hemodialysis: Influence on Plasma Refilling and Hemodynamic Stability

Hsu¹,

Swartz²,

Somermeyer³

et al. 1984

Nephron

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Unexpected seizures during hemodialysis

et al. 1987

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To assess the effects of the dialysate prescription on the intradialytic neurological stability of children requiring chronic hemodialysis (HD), continuous EEG monitoring (CEM) was performed on five children before, during and after HD against: (1) low sodium acetate (LAc: Na 132 mEq/l, acetate 38 mEq/l); (2) high sodium acetate (HAc: Na 144 mEq/l, acetate 41 mEq/l), and (3) low sodium bicarbonate (LBi: Na 133 mEq/l, bicarbonate 35 mEq/l) dialysate. Three children, two with clinically well-controlled seizure disorders and one with no seizure history, exhibited subclinical seizures on LAc and HAc but improved neurological stability on LBi. Two children had essentially unchanged CEM studies on any HD regimen. Symptoms of disequilibrium were noted in four of the five children on LAc, two of the five on HAc and only one of the five on LBi. The data suggest that bicarbonate HD may enhance intradialytic neurological stability, particularly in children with known seizure disorders. Furthermore, CEM was found to be a useful tool for evaluating the neurological stability of children during HD.

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