title: Comparison of sustained low-efficiency dialysis with acetate-free and acetate-containing bicarbonate dialysate in unstable patients.
abstract: This work is focused on the problem of maintenance of intradialytic hemodynamic safety in unstable patients with acute kidney injury (AKI). A hypothesis that "small" quantities of acetate in standard bicarbonate dialysate can cause pronounced acetatemia and exacerbate cardiovascular instability was tested. In this prospective randomized study, a group of patients with AKI after cardiac surgery was treated with sustained low-efficiency dialysis with either acetate-containing bicarbonate dialysate or acetate-free dialysate, where acetate is replaced by hydrochloric acid. It was demonstrated that application of acetate-containing bicarbonate dialysate results in blood acetate levels up to 12 times the normal level. Additionally, it is associated with a 3.8-fold-increased risk of hemodynamic complications in comparison with acetate-free dialysate. The choice of acetate-free or acetate-containing bicarbonate dialysate does not influence adequacy of correction of the acid-base and electrolyte content of blood.
authors.affiliation: Department of Anesthesiology and Critical Care, Academician E.N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Zaur M
authors.initials: ZM
authors.lastname: Unarokov
authors.forename: Tamara V
authors.initials: TV
authors.lastname: Mukhoedova
authors.forename: Olga V
authors.initials: OV
authors.lastname: Shuvaeva
mesh_terms: D019342:Acetic Acid / Q000032:analysis*; D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D001639:Bicarbonates / Q000032:analysis*; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015312:Hemodialysis Solutions; D019342:Acetic Acid
keywords: Acetate; Acetate-free dialysis; Acute kidney injury; Sustained low-efficiency dialysis