Studies on Circulatory Stability During Bicarbonate Hemodialysis with Constant Dialysate Sodium Versus Acetate Hemodialysis with Sequential Dialysate Sodium

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Abstract
Eight stable patients on maintenance hemodialysis were studied while undergoing acetate hemodialysis with a sequential dialysate Na concentration from 147 to 137 mEq/L (SNa-HDA) and bicarbonate hemodialysis with a constant dialysate Na concentration of 140 mEq/L (HDB). Circulatory behavior was observed during both of these methods; both were found to allow a high volume removal. However, as a consequence of the high Na load during SNa-HDA, volume was shifted from the extra- to the intravascular space. This stabilizing effect on the circulation disappeared with the sequential decrease of dialysate Na concentration (despite a constant plasma Na concentration of .apprx. 140 mEq/L), which was concomitant with a significant decline of the mean arterial blood pressure and an inadequate compensation of the metabolic acidosis. In contrast, a better circulatory response to comparable volume removal was found during HDB, expressed by a stable mean artificial blood pressure in the presence of well-balanced arterial acid-base values.

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