Hypoxemia during hemodialysis using acetate versus bicarbonate dialysate

American Journal of Nephrology
D K Abu-HamdanF D McDonald

Abstract

To evaluate the extent and cause(s) of dialysis-related hypoxemia, we studied 10 patients, 7 days apart using acetate (AC) and bicarbonate dialysate (HCO3). We measured arterial blood gases, WBC, minute ventilation (VE) and inspired and expired gas concentrations and calculated the respiratory quotient (R) and the alveolar-arterial oxygen difference (A-a)DO2 before and during hemodialysis. 8 patients developed hypoxemia. Arterial PO2 (PaO2) dropped similarly at 30 min from 93 +/- 5 to 78 +/- 6 (p less than 0.05) and 89 +/- 4 to 79 +/- 5 mm Hg (p less than 0.05) with AC and HCO3, respectively. R and VE decreased during AC (p less than 0.05). (A-a)DO2 increased at 30 min and correlated with the drop in PaO2 during both AC (r = 0.68, p less than 0.025) and HCO3 (r = 0.76, p less than 0.025). The fall in PaO2 also correlated with the fall in WBC count for both AC and HCO3 (r = 0.63, p less than 0.005). The increase in arterial pH during HCO3 (up to 7.45 +/- 0.01) was significantly greater than that during AC (up to 7.42 +/- 0.01) (p less than 0.025), and coincided with a relative decrease in VE. We conclude that (1) HCO3 does not prevent hypoxemia, and (2) hypoventilation V/Q abnormalities and increase in arterial pH, contribute va...Continue Reading

Citations

Jan 9, 2010·Critical Care : the Official Journal of the Critical Care Forum·Roberto Alberto De BlasiPaolo Menè
Apr 12, 2013·Nephro-urology Monthly·Ali MomeniMasoud Amiri
Sep 1, 1985·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·A R Eiser
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Jul 9, 2004·Advances in Chronic Kidney Disease·F Dumler, Peter A McCullough
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Related Concepts

Cuprammonium cellulose
Acetic Acids
Metabolic Acidosis
Anoxemia
Carbonic Acid Ions
Carbon Dioxide
Alphacel
Hemodialysis
Hydrogen-Ion Concentration
Hypoventilation

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