Phosphorus removal with a variable chloride, CO2 acidified dialysate using an unmodified single pass system.
A method of providing dialysate was developed that used CO2 gas, rather than acetic acid, as an acidifying agent, allowing for the delivery of a variable chloride concentration. The system can be used on a standard, unmodified dialysis machine. The aim of the study was to test the technical feasibility of the dialysate delivery system and to determine whether use of the dialysate, which is free of acetate and can increase serum chloride concentrations above those normally achieved during the early phases of dialysis, could influence mass phosphorus removal. Using a crossover design, the effects of a standard acetate containing dialysate were compared with the acetate free, variable chloride dialysate on serum phosphorus kinetics and mass phosphorus removal in six hemodialysis patients. Although, as predicted, the serum chloride levels were higher during the initial phases of dialysis and serum bicarbonate concentrations were equivalent at the end of treatment, it was not possible to measure any differences in serum phosphorus levels during any of the time points during or immediately after dialysis, nor was any difference in mass phosphorus removal observed. Despite the presence of considerable animal evidence that acetate metabolism causes the intracellular shift of phosphorus, our study did not show any benefit, in terms of mass phosphorus removal, of an acetate free dialysate solution.
Briefel
G R
GR
Department of Renal Medicine, Francis Scott Key Medical Center, Baltimore, MD 21224.
Anderson
J E
JE
D000085:Acetates / Q000737:chemistry; D001639:Bicarbonates / Q000097:blood; D001774:Blood Chemical Analysis; D001786:Blood Glucose / Q000032:analysis; D001806:Blood Urea Nitrogen; D002245:Carbon Dioxide / Q000097:blood / Q000737:chemistry*; D002712:Chlorides / Q000097:blood*; D003404:Creatinine / Q000097:blood; D018592:Cross-Over Studies; D004573:Electrolytes / Q000097:blood; D005240:Feasibility Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010313:Partial Pressure; D010758:Phosphorus / Q000097:blood*; D012015:Reference Standards; D006435:Renal Dialysis / Q000379:methods / Q000592:standards*
D000085:Acetates; D001639:Bicarbonates; D001786:Blood Glucose; D002712:Chlorides; D004573:Electrolytes; D002245:Carbon Dioxide; D010758:Phosphorus; D003404:Creatinine