This study was conducted to compare the effects of acetate dialysate and bicarbonate dialysate on ABGA, blood pressure and symptoms which occur during hemodialyses in chronic stable dialysis patients. 26 patients (13 male and 13 female) with
chronic
renal failure participated in this study.
Hemodialyses performed with acetate dialysate having 37 mEq/L acetate and bicarbonate dialysate having 8mEq/L acetate and 30mEq/L bicarbonate. Each blood sample was drawn for ABTGA through arterial line of A. V fistula at 0, 1, 2 and 4 hours
during
hemodialysis. Serum electrolytes changes between 0 hour and 4 hours during hemodialvsis were also studied. Blood pressure change and occurrence of symptoms during hemodialysis were observed.
@ES The results are as follows.
@EN In acetate dialysis group, there was no significant increase of pH at 1 hour compared with that of predialysis, but pH increased significantly after 2 hours. In bicarbonate dialysis group, pH increased significantly 1, 2 and 4 hours compared
with
those of pre-dialysis.
PaCO2 increased increased significantly at 1 hour after hemodialysis in both groups and returned to baseline values at 4 hours. In acetate dialysis, PaO2 decreased significantly at 1 hour and 2 hours (p<0.05), but in blcarbonate dialysis it
decreased
significantly only at 1 hour. HCO3 increased significantly form 1 hour after dialysis in both groups.
Between acetate and bicarbonate dialysis, pH and HCO3 at 1, 2 and 4 hours were significantly higher in bicarbonate group (p<0.05), but there was no difference in PaCoO2 all the time. PaO2 level was higher at 1, 2 and 4 hours in bicarbonate
dialysis
compared with those of acetate dialysis without statistical significance.
Serum Na+, K+, P-decreased significantly at 4hours compared with those of pre-dialysis values, Serum Ca++ level increased significantly after 4 hours of hemodialysis. Serum electrolytes values were not different between acetate and bicarbonate
dialysis
group.
Percent reduction of blood pressure showed greater systolic blood pressure reduction in acetate dialysis compared with that of bicarbonate dialysis, but diastolic blood pressure showed no statistical difference.
Symptoms such as headache, post dialysis fatigue, nausea, vomiting, diziness and abdominal pain developed frequently (p<0.05) in acetate dialysate group.
In summary we concluded that bicarbonate dialysis corrects metabolic acidosis rapidly and has less deleterious symptoms and less blood pressure decrement than acetate dialysis does. We also noted that PaO2 decrement was milder and shorter in
duration in
bicarbonate dialysis than in acetate dialysis.
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