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      Bicarbonate Hemodialysis: Influence on Plasma Refilling and Hemodynamic Stability

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          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

          S. Karger AG
          04 December 2008
          : 38
          : 3
          : 202-208
          Division of Nephrology, V.A. Medical Center and University of Michigan Medical Center, Ann Arbor, Mich., USA
          183308 Nephron 1984;38:202–208
          © 1984 S. Karger AG, Basel

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          Pages: 7
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