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      Bicarbonate Hemodialysis: Influence on Plasma Refilling and Hemodynamic Stability

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          Abstract

          The present study compares the effect of sodium bicarbonate (LoNaHCO<sub>3</sub>, Na = 134, HCO<sub>3</sub> = 33 mEq/l) and sodium acetate (LoNaAc, Na =134, acetate 33 mEq/l) dialysate on the extravascular fluid mobilization (V<sub>FM</sub>) and hemodynamic changes in 6 patients during 3 h of hemodialysis with equivalent fluid ultrafiltration of about 600 ml/h. The cumulative decrease in plasma volume after 1, 2 and 3 h of dialysis was significantly less during LoNaHC0<sub>3 </sub>dialysis than during LoNaAc dialysis, with plasma volume almost completely refilled by V<sub>FM</sub> during the first 2 h of LoNaHCO<sub>3</sub> dialysis. High sodium acetate dialysate (HiNaAc, Na = 144, acetate = 33 mEq/l) with equivalent fluid ultrafiltration also resulted in less net decrease in plasma volume and greater V<sub>FM</sub> than LoNaAc, although the temporal pattern of refilling was somewhat different from that during LoNaHCO<sub>3</sub>: rapid and complete refilling during the early portion of LoNaHCO<sub>3</sub>, slower and more progressive refilling during HiNaAc, with similar cumulative refilling for LoNaHCO<sub>3</sub> and HiNaAc by 3 h. Mean arterial pressure (MAP) tended to decrease during LoNaAc dialysis, whereas MAP remained stable during LoNaHCO<sub>3</sub> and increased slightly during HiNaAc. This study, therefore, suggests that improved hemodynamic stability utilizing bicarbonate dialysate may be due, in part, to greater plasma refilling and better preservation of plasma volume.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1984
          1984
          04 December 2008
          : 38
          : 3
          : 202-208
          Affiliations
          Division of Nephrology, V.A. Medical Center and University of Michigan Medical Center, Ann Arbor, Mich., USA
          Article
          183308 Nephron 1984;38:202–208
          10.1159/000183308
          6092982
          © 1984 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Original Paper

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