High sodium bicarbonate and acetate hemodialysis: double-blind crossover comparison of hemodynamic and ventilatory effects.
The superiority of bicarbonate dialysis (Bi HD) over acetate dialysis (Ac HD) using a high sodium dialysate has not been established to our knowledge. We compared to Bi HD to Ac HD over 6 weeks each in ten stable patients using a double-blind crossover design and a dialysate sodium concentration of 140 mEq/liter. The dialyzer, delivery system, and disalysate constituents were identical except for the substitution of Bi or Ac. Interdialytic weight gain, pre- and post-HD blood pressures, and heart rates were also comparable in the two protocols. Beginning of the week pre-HD serum Bi was greater during Bi HD than Ac HD (19.1 +/- 0.9 vs. 15.1 +/- 0.8 mEq/liter, P less than 0.001); post-HD Bi values were also higher during Bi HD. Similarly, pre-HD pH was also greater with Bi HD 7.40 +/- 0.012 vs. 7.35 +/- 0.001 U, P less than 0.01). The number of adverse symptoms and signs were similar during each protocol (2.0 +/- 0.65 for Bi HD vs. 2.5 +/- 0.5 for Ac HD episodes/patient/6 weeks, NS). However, fewer therapeutic interventions were required during the Bi HD protocol (1.5 +/- 0.43 vs. 3.1 +/- 0.6 treatments/patient/6 weeks, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
D000085:Acetates; D000368:Aged; D001639:Bicarbonates; D001794:Blood Pressure; D001835:Body Weight; D004311:Double-Blind Method; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D011653:Pulmonary Diffusing Capacity; D006435:Renal Dialysis; D012119:Respiration; D017693:Sodium Bicarbonate; D014692:Ventilation-Perfusion Ratio
D000085:Acetates; D001639:Bicarbonates; D017693:Sodium Bicarbonate