[Hemodialysis with bicarbonate 30 mEq/l versus 34 mEq/l and acetate: better hemodynamic tolerance and electrolyte and acid-base homeostasis].
The use of bicarbonate buffer in dialysis is more physiological than acetate. The aim of this prospective study was to compare the hemodynamic stability, acid-base and electrolyte balance changes in a group of 5 hospital hemodialysis (HD) patients, with 3 different dialysis fluids: one with 30 mEq/l of bicarbonate (B30), another with 34 mEq/l of bicarbonate (B34) and the last with acetate (ACE). All the patients had more than 12 months in HD. Each patient had HD treatment with one of the 3 different dialysis fluids: ACE, B30, B34. Each HD had a duration of 4 hours, with less than 5% dry weight ultrafiltration (UF) and continuous cardiac monitoring. The following clinical and laboratory data were evaluated: arterial blood pressure (BP), cardiac rate (CR), respiratory rate (RR), cardiac arrhythmias, blood urea, creatinine, sodium, potassium, magnesium, total calcium (Ca), ionised calcium (Ca++), pH, bicarbonate (HCO3-) and pCO2. Statistic analysis was performed using Student's paired t test and ANOVA with Bonferroni correction. Clinical evaluation showed a CR increase only in the ACE group (pre X = 78.4 to 4 degrees h X = 102.6 p < 0.001). Analytical results demonstrated, at the 1st h, Ca++ stability in the B30 group; in the first 30' the pH decreased in the ACE group (pre X = 7.35 to 30' X = 7.34); during HD, HCO3- was not corrected in the ACE group (pre X = 19.4 to 4th h X = 20.0); at 4th, pCO2 also decreased in this group (pre X = 34.5 to 4th h X = 28.4 p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Bruges
M
M
Serviço de Nefrologia, Hospital de Santa Cruz, Carnaxide.
Barata
J D
JD
Oliveira
C
C
Furstenau
C
C
Gomes
E M
EM
Simões
J
J
D000085:Acetates / Q000008:administration & dosage*; D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000328:Adult; D000704:Analysis of Variance; D001639:Bicarbonates / Q000008:administration & dosage*; D005069:Evaluation Studies as Topic; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000187:drug effects*
D000085:Acetates; D001639:Bicarbonates; D015312:Hemodialysis Solutions
Hemodiálise com bicarbonato 30 mEq/l versus 34 mEq/l e acetato: a melhor tolerância hemodinâmica e homeostasia electrolítica e ácido-base.