Acetate metabolism during hemodialysis: metabolic considerations

American Journal of Nephrology
P VinayL Lapierre

Abstract

Acetate is used during regular hemodialysis to replace the bicarbonate lost during dialysis. The temporal changes of plasma bicarbonate and acetate concentrations and the critical role of acetate metabolism for the maintenance of plasma bicarbonate are described. We point out that the maximal rate of acetate oxidation in man is usually reached during dialysis, and we identify physiologic and pathologic factors that may modify this Vmax. A syndrome of 'intolerance to acetate' has been described. This syndrome is analyzed in the light of the metabolic consequences of a rapid flux of acetate oxidation in liver and muscle cells. More specifically, the effects of rapid acetate metabolism on tissue ATP, CoA, adenosine and other ATP degradation products are presented. The possible impact of dialysis-induced depletion of carnitine on optimal acetate metabolism is discussed. The potential clinical consequences produced by these changes are presented in relation to the symptoms sometimes observed during dialysis against acetate: vasodilation, hypotension and angina pectoris. The hypoxemia induced by acetate is also briefly reviewed. Different directions are proposed for future research.

Citations

Jun 23, 2001·Biochimica Et Biophysica Acta·H YamashitaK Tagawa
Apr 1, 1988·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·M CardosoL Lapierre
Mar 1, 1989·Kidney International·J P MontiR Elsen
Sep 30, 2004·American Journal of Physiology. Endocrinology and Metabolism·Paul A RobertsPaul L Greenhaff
Jun 1, 1991·Alcoholism, Clinical and Experimental Research·W E Lands
Apr 3, 2019·Seminars in Dialysis·Jaime Uribarri, Man S Oh
Nov 25, 2016·Journal of the American Society of Nephrology : JASN·Matthew K Abramowitz
May 1, 1995·The American Journal of Physiology·C T PutmanG J Heigenhauser

Related Concepts

Acetic Acids
Carbonic Acid Ions
Hemodialysis
Kidney Failure, Chronic

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