PMID: 3128109Apr 1, 1988

Hypoxemia during hemodialysis: a critical review of the facts

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
M CardosoL Lapierre

Abstract

The literature describing the fall in PaO2 during dialysis is intensively and critically reviewed. This phenomenon is related to both the type of membrane used (cellulosic v noncellulosic membrane), and to the composition of the dialysate (acetate v bicarbonate). It appears that a ventilation/perfusion mismatch due to pulmonary leukostasis can, in part, explain hypoxemia in patients dialyzed with cellulosic membranes. This phenomenon is especially apparent in patients with preexisting pulmonary abnormalities. However, hypoventilation remains the major cause of hypoxemia. This hypoventilation is mainly due to CO2 consumption during acetate metabolism (acetate dialysis), or alkalinization of the blood (bicarbonate dialysis). The metabolic consequences of acetate metabolism, and of bicarbonate and CO2 losses through the dialyzer are critically analyzed. The cause for the increment in oxygen consumption during acetate dialysis is examined. Finally, the respective role of these combined factors are described and used to explain the changes in VCO2, VO2, respiratory quotient (RQ), and PaO2 reported in the literature during dialysis against acetate and/or bicarbonate.

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Citations

Jun 2, 2009·Journal of Medical Engineering & Technology·N S Al-WailiR Petrillo
Dec 1, 1994·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·J M Lazarus, W F Owen
Mar 5, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Anna Meyring-WöstenPeter Kotanko
Jun 30, 2000·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·M A MungerE H Marshall
Sep 1, 1995·Scandinavian Journal of Urology and Nephrology·N LøkkegaardP B Brekke
Jul 21, 2000·Scandinavian Journal of Urology and Nephrology·Y YeniçeriogluE S Uçan
Apr 1, 1993·Scandinavian Journal of Clinical and Laboratory Investigation·G NielsenC Nielsen
Nov 18, 2017·Seminars in Dialysis·Qi Qian
Mar 14, 2008·Journal of Renal Care·Karen Latchford, Jan Cowperthwaite
Jan 1, 1995·Acta Anaesthesiologica Scandinavica. Supplementum·A L NielsenP Thunedborg
Nov 10, 2020·KI Reports·Bernard CanaudPeter Kotanko

Related Concepts

Anoxemia
Carbon Dioxide
Hemodialysis
Membranes, Artificial
Dioxygen
Oxygen Consumption
Respiration

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