Kohnle W, Heimsch E, Schmidt-Wiederkehr P, Franz H E
J Dial. 1977;1(5):419-30. doi: 10.3109/08860227709082378.
Treatment of chronic uremia by hemodiafiltration requires replacement of the filtrate. Using Ringer's solution alone, there is a depression of pH because of bicarbonate loss. To bring the acid base status back to normal, sodium lactate in increasing concentrations (283 mg% = 32 mM/1, 361 mg% = 40 mM/1; 462 mg% = 51 mM/1; 508 mg% = 57 mM/1) was added to the replacement fluid. The optimal concentration is 450 mg% (=50 mM/1) sodium lactate, provided the following conditions are fulfilled: (a) substitution after the filter; (b) mixing ratio of blood and substitution fluid 1:2. Using 12-15 liters of substitution fluid during a 5 hr treatment, the added lactate amounts to 60 g (=0.54 M). With continuous addition of lactate, the serum concentration of lactate is 3.5 times normal and the concentration of serum pyruvate 4 times normal. An excess lactate concentration, according to Huckabee [1,2], was thus not observed. The sieving coefficients were the following: sodium, potassium, urea, lactate, pyruvate, and phosphate 1; chloride greater then 1; calcium and protein less than 1. Serum osmolality fell, on the average, 9 mOsmol/1 during diafiltration.
通过血液透析滤过治疗慢性尿毒症需要补充滤液。单独使用林格氏液时，由于碳酸氢盐的丢失会导致pH值下降。为使酸碱状态恢复正常，在置换液中加入浓度递增的乳酸钠（283mg% = 32mM/1，361mg% = 40mM/1；462mg% = 51mM/1；508mg% = 57mM/1）。如果满足以下条件，最佳浓度为450mg%（=50mM/1）乳酸钠：(a)在滤器后进行置换；(b)血液与置换液的混合比例为1:2。在5小时的治疗过程中使用12 - 15升置换液，所添加的乳酸量达60g（=0.54M）。持续添加乳酸后，血清乳酸浓度为正常的3.5倍，血清丙酮酸浓度为正常的4倍。因此，未观察到如哈克比[1,2]所述的乳酸浓度过高的情况。筛分系数如下：钠、钾、尿素、乳酸、丙酮酸和磷酸盐为1；氯大于1；钙和蛋白质小于1。在透析滤过过程中，血清渗透压平均下降9mOsmol/1。
