title: [Acute kidney failure in a resuscitation milieu: improvement of dialysis tolerance using bicarbonates in the dialysate].
abstract: Patients hospitalized in critical care unit for acute renal failure (ARF) in a multiorgan failure syndrome have often a poor intra-dialysis tolerance. Change from Ac to Bi for dialysate buffering has been advocated to improve this dialytic tolerance. In a retrospective study, 70 patients who received Bi hemodialysis are compared with 106 patients who received Ac hemodialysis. If the mortality is not different between these two groups, intra-dialysis tolerance is significantly better (p less than 0.001) in the Bi group according to the mean intra-dialysis systolic blood pressure decrease, the collapse occurrence and the mean vascular volume infusion. Ultrafiltration rate is higher and reach more often the desired values. On a biochemical point of view, hemodialysis efficacy is the same in the two groups according to urea and creatinin clearance, but end dialysis Bi plasma concentrations are higher and nearer of the normal range in the Bi group even though predialysis Bi plasma concentrations were similar. The only side effect observed with Bi dialysis was a hypoglycemic episode without clinical consequence, due to the lack of glucose in the bicarbonate dialysate. Nevertheless, in patients under controlled ventilation, a end dialysis alkalosis can occur if a hyperventilation is imposed. Change from Ac to Bi in dialysate buffering improves the intra-dialysis tolerance of patients with ARF in a multiorgan failure syndrome. This kind of hemodialysis is now used routinely in our critical care unit.
mesh_terms: D000085:Acetates; D058186:Acute Kidney Injury / Q000628:therapy*; D001639:Bicarbonates; D003422:Critical Care; D004361:Drug Tolerance; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects; D012151:Resuscitation; D012189:Retrospective Studies
chemical_list: D000085:Acetates; D001639:Bicarbonates
vernacular_title: Insuffisance rénale aiguë en milieu de réanimation: amélioration de la tolérance dialytique par l'utilisation de bicarbonate dans le dialysat.