The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure.
OBJECTIVE
To determine the impact of different hemofiltration (HF) replacement fluids on the acid-base status and cardiovascular hemodynamics in patients with acute renal failure (ARF) and continuous veno-venous hemofiltration (CVVH).


METHODS
Prospective, cohort study.


METHODS
Intensive Care Unit of the Heinrich Heine University Hospital, Düsseldorf, Germany.


METHODS
One hundred and thirty-two critically ill patients with acute renal failure and continuous veno-venous HF were studied. Fifty-two patients were subjected to lactate-based (group 1), and 32 to acetate-based hemofiltration (group 2) while 48 (group 3) were treated with bicarbonate-based buffer hemofiltration fluid. Fifty-seven had a septic, and 75 a cardiovascular, origin of the ARF. Creatinine, blood urea nitrogen (BUN), serum bicarbonate, arterial pH, lactate and Apache II scores were noted daily.


RESULTS
The mean CVVH duration was 9.8 +/- 8.1 days, mortality was 65%. No difference was present between the groups under investigation with regard to the main clinical parameters. Lactate- and bicarbonate-based hemofiltration led to significantly higher serum bicarbonate and arterial pH values as compared to the acetate-based hemofiltration. Serum bicarbonate values at 48 h after the initiation of CVVH treatment were 25.7 +/- 3.8 mmol/l (p < 0.001) in group 1, 20.6 +/- 3.1 mmol/l in group 2 and 23.3 +/- 3.9 mmol/l (p < 0.001) in group 3. While a lack of increase in serum bicarbonate and arterial pH was correlated to poor prognosis in lactate- and bicarbonate-based hemofiltration, no such observation was made in acetate-based hemofiltration. Cardiovascular hemodynamics were superior in patients treated with lactate- and bicarbonate-based buffer solution as compared to those treated with acetate-based buffer solution.


CONCLUSIONS
The degree of correction of acidosis during hemofiltration was determined by patient outcome in patients treated with lactate- and bicarbonate-based buffer solutions, but not in patients receiving acetate-buffered solution. Bicarbonate and lactate-based buffer solutions were found to be superior to acetate-based replacement fluid.
Heering
P
P
Department of Nephrology and Rheumatology, Heinrich Heine University of Düsseldorf, Germany.
Ivens
K
K
Thümer
O
O
Morgera
S
S
Heintzen
M
M
Passlick-Deetjen
J
J
Willers
R
R
Strauer
B E
BE
Grabensee
B
B
D018806:APACHE; D000136:Acid-Base Equilibrium; D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D001639:Bicarbonates / Q000097:blood; D002021:Buffers; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004573:Electrolytes / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019346:Sodium Acetate / Q000627:therapeutic use*; D017693:Sodium Bicarbonate / Q000097:blood / Q000627:therapeutic use*; D019354:Sodium Lactate / Q000097:blood / Q000627:therapeutic use*
D001639:Bicarbonates; D002021:Buffers; D004573:Electrolytes; D007773:Lactates; D019346:Sodium Acetate; D017693:Sodium Bicarbonate; D003404:Creatinine; D019354:Sodium Lactate