On-line haemodiafiltration with and without acetate.
BACKGROUND
In patients on on-line convective treatments, given the considerable quantity of dialysis fluid re-infused, the small amount of acetate present in bicarbonate dialysis fluid as a pH stabilizing factor may allow a significant transfer of that anion to the patient, possibly inducing cytokine activation.


METHODS
To verify this hypothesis, we performed on-line haemodiafiltration (OL-HDF) with (3 mmol/l) and without acetate in dialysis fluid in a cross-over randomized order on 12 prevalent patients.


RESULTS
In comparison with the pre-treatment values, plasma acetate levels were unchanged during and after acetate-free OL-HDF, while they were 5-6 times higher in the course of OL-HDF containing acetate in dialysis fluid; plasma acetate levels returned to basal values 2 h after the end of the procedure. The total increase of bases in the patient attributable to acetate was 36%. Plasma bicarbonate values at the end of treatment were significantly lower in treatments without acetate, as compared to those with acetate. Interleukin-6 plasma levels were super-imposable at the beginning and in the course of the two methods compared, but there was a tendency towards a greater increase at an interval of 2 h following OL-HDF with acetate.


CONCLUSIONS
Our preliminary results confirm the assumption that body gain of acetate is particularly high in convective treatments, while acetate-free OL-HDF slows down acetate burden. Clinical advantages due to these effects should be evaluated in properly designed prospective studies.
Pizzarelli
Francesco
F
Nephrology and Dialysis Unit, SM Annunziata Hospital, Florence, Italy. fpizzarelli@yahoo.com
Cerrai
Tiziano
T
Dattolo
Pietro
P
Ferro
Giuseppe
G
D000085:Acetates / Q000097:blood* / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D001639:Bicarbonates / Q000097:blood / Q000627:therapeutic use; D001784:Blood Gas Analysis; D018592:Cross-Over Studies; D016207:Cytokines / Q000187:drug effects; D004573:Electrolytes / Q000097:blood; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000494:pharmacology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009862:Online Systems
D000085:Acetates; D001639:Bicarbonates; D016207:Cytokines; D004573:Electrolytes; D015312:Hemodialysis Solutions; D015850:Interleukin-6