Korean Journal of Nephrology 1993;12(3):397-407.

초산과 중탄산나트륨 투석액을 이용한 혈액투석의 비교 분석

정성복 , 임종식 , 윤경우

Abstract

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 renai failure participated in this study. Hemodialyses performed with acetate dialysate hav- ing 37 mEq/L acetate and bicarbonate dialysate having 8 mEq/L acetate and 30 mEq/L bicarbonate. Each blood sample was drawn for ABGA 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 hemodialysis were also studied. Blood pressure change and occurrence of symptoms during hemo- dialysis were observed. The results are as follows. 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 predialysis. PaCO, increased significantly at 1 hour after hemodialysis in both groups and returned to baseline values at 4 hours. In acetate dialysis, PaO, decreased significantly at 1 hour and 2 hours (p<0.05), but in bicarbonate dialysis it decreased significantly only at 1 hour. HCO, increased significantly from 1 hour after dialysis in both groups. Between acetate and bicarbonate dialysis, pH and HCO, at 1, 2 and 4 hours were significantly higher in bicarbonate group (p<0.05), but there was no difference in PaCO, all the time. PaO, 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 4 hours compared with those of predialysis values. Serum Ca" leve@l increased significantly after 4 hours of hernodialysis. Serum electralytes 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 dias- tolic blood pressure showed,no statistical difference. Symptoms such as headache, post-dialysis fatigue, nausea, vomiting, dizziness and abdominal pain devel- oped frequently (p<0.05) in acetate dialysate group. In summary we concluded that bicarbonate dialysis corrects metabolic acidosis more rapidly and has less deleterious symptoms and less blood pressure decrement than acetate dialysis does. We also noted that PaO, decrement was milder and shorter in duration in bicarbonate dialysis than in acetate dialysis.