| Abstract: | Changes in pH and blood gases were studied during hemodialysis with both acetate and bicarbonate dialysates. During acetate dialysis, Pao2 and Paco2 decreased significantly (P < 0.05) from 101 ± 2 to 93 ± 3 mmHg and from 34.4 ± 1.0 to 31.8 ± 0.9 mmHg, respectively, whereas during bicarbonate dialysis neither parameter changed significantly. The final pH was 7.45 ± 0.01 during acetate dialysis and 7.50 ± 0.02 during bicarbonate dialysis. Plasma bicarbonate rose immediately and progressively from 18.9 ± 0.8 to 26.8 ± 0.9 mmol/L with bicarbonate dialysis, whereas the increase was moderate, from 19.6 ± 0.6 to 22.3 ± 0.5 mmol/L, with acetate dialysis. These data indicate that dialysis-induced hypoxemia was prevented and correction of acidosis was more adequate with bicarbonate dialysis. During a two-year period on bicarbonate dialysis, total cholesterol, HDL-cholesterol, and triglycerides did not change significantly when compared to acetate dialysis. The most striking change was the increased tolerance to dialysis with bicarbonate dialysis, which included a 50% reduction in hypotensive episodes and muscle cramps and an almost complete absence of headache, nausea, and vomiting. |
