Which bicarbonate concentration is adequate to lactate-buffered substitution fluids in maintenance hemofiltration?
We investigated the metabolic and hemodynamic effects of a lactate- and a bicarbonate-buffered (bicarbonate concentration 31.4 mmol/l, type I) hemofiltration substitution fluid in a prospective crossover study of 3 weeks each in 11 patients on maintenance hemofiltration. The lactate-buffered hemofiltration (lactate concentration 34-44.5 mmol/l) lead to hyperlactatemia in all patients without signs of overt lactic acidosis but showed a better control of acid-base balance (pH, base excess, standard bicarbonate) than the type I bicarbonate-buffered fluid (p < 0.01). In 6 patients a higher concentration of bicarbonate- (39.7 mmol/l, type II) buffered fluid was tested. The parameters of acid-base balance showed a better control during type II than during type I bicarbonate hemofiltration and were similar to the lactate-buffered phase. Plasma lactate levels between type I and type II bicarbonate hemofiltration were not different. Also in the steady state phase of the treatment (days 7-9 [week 3]) parameters of acid-base balance rose more to normal values during type II than during lactate-buffered hemofiltration. Hemodynamic parameters showed no differences between the three types of buffers used. Furthermore, also the type II bicarbonate fluid was well tolerated. Bicarbonate in a higher concentration (39.7 mmol/l) proved to be a safe and practical alternative to lactate-buffered hemofiltration.
II. Medical Clinic, Technical University of Aachen, Germany.
R
R
Böhm
U
U
Gladziwa
W
W
Clasen
J
J
Riehl
H
H
Mann
H G
HG
Sieberth
D000136:Acid-Base Equilibrium / Q000502:physiology; D000138:Acidosis / Q000517:prevention & control*; D001639:Bicarbonates; D002021:Buffers; D018592:Cross-Over Studies; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D007773:Lactates; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D001639:Bicarbonates; D002021:Buffers; D015312:Hemodialysis Solutions; D007773:Lactates; D019344:Lactic Acid