Metabolic effects of hemodialysis with and without glucose in the dialysate.
This study was conducted in eight acute renal failure patients undergoing mechanical ventilation to test if the addition of glucose in the dialysate prevents metabolic and hormonal changes induced by hemodialysis. Hemodialysis was performed with a bicarbonate dialysate, a polyacrilonitrile membrane and a continuous heparinization. Two four-hour hemodialysis sessions were performed in each patient: one without glucose (GFD) and one with glucose (GD) in the dialysate at a concentration close to each patient's initial plasma glucose concentration. Oxygen consumption and carbon dioxide elimination, glucose insulin, aceto-acetate and free fatty acids were measured before, during and after the sessions. Oxygen consumption and carbon dioxide elimination were measured with a system using a mass spectrometer. Hemodynamic state and temperature remained constant. Before hemodialysis, respiratory quotient (RQ) values were the same in both groups. There was no change in RQ during GD. There was a decrease in RQ during GFD. Glucose and insulin concentrations decreased during GFD and remained unchanged during GD. Aceto-acetate concentration remained constant under both conditions. Free fatty acids concentration increased to the same extent during GD and GFD. The authors conclude that the addition of glucose in the dialysate prevents the decrease in RQ induced by hemodialysis. This effect is most likely related to a decreased mobilization of non-glucidic fuels.
Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
Y
Y
Bouffard
S
S
Tissot
B
B
Delafosse
J P
JP
Viale
G
G
Annat
O
O
Bertrand
J
J
Motin
D058186:Acute Kidney Injury / Q000097:blood / Q000378:metabolism* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015314:Dialysis Solutions; D004734:Energy Metabolism; D005260:Female; D005544:Forecasting; D005947:Glucose; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012119:Respiration; D012146:Rest
D015314:Dialysis Solutions; D005947:Glucose