Gas exchange during dialysis. Contrasting mechanisms contributing to comparable alterations with acetate and bicarbonate buffers

The American Journal of Medicine
J M HuntL J Rubin

Abstract

Although arterial hypoxemia during hemodialysis is common and may contribute to dialysis morbidity, the mechanisms responsible remain uncertain. Additionally, controversy exists as to whether bicarbonate dialysate produces less hypoxemia than acetate dialysate. The short- and long-term effects of acetate dialysate and bicarbonate dialysate on gas exchange were compared in eight stable patients undergoing dialysis using a closed, proportioning system and a double-blind, crossover study design. Dialysate was sampled immediately proximal and distal to the dialyzer to determine its contribution to total carbon dioxide elimination. Ventilatory parameters and blood gas values were measured before dialysis, at one hour, and after dialysis. Arterial oxygen tension fell significantly and comparably at one hour with both dialysates, whereas the alveolar-arterial oxygen gradient increased only slightly. Despite hypoxemia, minute ventilation decreased by 4 to 18 percent, and arterial carbon dioxide tension was unchanged. Although total carbon dioxide elimination was unchanged in all groups, there was a significant decrease in lung total carbon dioxide elimination with acetate dialysate of 9.23 +/- 2.69 to 7.74 +/- 1.57 mmol per minute on D...Continue Reading

Citations

Apr 12, 2013·Nephro-urology Monthly·Ali MomeniMasoud Amiri
Jan 1, 1992·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·J U Leititis, M Brandis
Jul 1, 1991·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·W E Harmon
May 17, 2006·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Robert J HinchliffeFran Game
Sep 1, 1995·Scandinavian Journal of Urology and Nephrology·N LøkkegaardP B Brekke
Aug 17, 1990·Klinische Wochenschrift·S GrosserH Greten

Related Concepts

Acetic Acids
Anoxemia
Carbonic Acid Ions
Ampholytes
Carbon Dioxide
Clinical Trials
Double-Blind Method
Hemodialysis
Hydrogen-Ion Concentration
Kidney Failure, Chronic

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