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Original Paper

Does Bicarbonate Transfer Have Relevant Hemodynamic Consequences in Standard Hemodialysis?

Gabutti L.a · Ross V.b · Duchini F.b · Mombelli G.b · Marone C.c

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Departments of aNephrology and bInternal Medicine, Ospedale la Carità, Locarno, and cDepartment of Internal Medicine, Ospedale San Giovanni, Bellinzona, Switzerland

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Blood Purif 2005;23:365–372

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: November 03, 2004
Accepted: May 02, 2005
Published online: August 25, 2005
Issue release date: August 2005

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 5

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Background: In a previous study we demonstrated that mild metabolic alkalosis resulting from standard bicarbonate hemodialysis induces hypotension. This study aimed to compare hemodynamic consequences of either a decrease in the dialysate bicarbonate from 32 to 26 mmol/l or an increase in the dialysate calcium of 0.25 mmol/l and to verify whether the calcium shift secondary to alkalemia explains the consequences on blood pressure. Methods: In this randomized controlled trial with a single-blind, cross-over design, we used dialysis liquids with two different bicarbonate (32 mmol/l in modalities A and C, and 26 mmol/l in modality B) and calcium (1.25 mmol/l in modalities A and B, and 1.50 mmol/l in modality C) concentrations, and in 27 patients, 243 dialysis sessions, compared blood pressure, heart rate and the incidence of hypotension. Results: No significant differences were seen between A and B while an increase in systolic and diastolic blood pressures and a decrease in the incidence of hypotension (10.5 vs. 1.2%, p < 0.05) were documented in C. The subgroup of patients who with A showed a lower mean systolic blood pressure received more angiotensin-converting enzyme inhibitors or angiotensin II type-1 receptor blockers (36 vs. 0%, p <0.05) and in C showed a less important increase in systolic and diastolic pressures, but the incidence of hypotensive episodes between A and B was not significantly different (9.1 vs. 15.1%). Conclusions: In the present study it was not possible to demonstrate hemo dynamic instability associated with mild metabolic alkalosis. Even in the subgroup showing a lower blood pressure with a higher dialysate bicarbonate, significant hemodynamic or clinical consequences were not noticed. The calcium shift (0.05 mmol/l) related to alkalemia would justify a mean decrease in systolic blood pressure of only about 1 mm Hg.

© 2005 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: November 03, 2004
Accepted: May 02, 2005
Published online: August 25, 2005
Issue release date: August 2005

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 5

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU


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