Panesar Mandip, Shah Neal, Vaqar Sarosh, Ivaturi Kaushik, Gudleski Gregory, Muscarella Mary, Lambert Judy, Su Winnie, Murray Brian
The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.
Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
Ther Apher Dial. 2017 Apr;21(2):157-165. doi: 10.1111/1744-9987.12510. Epub 2017 Mar 13.
Fresenius Medical Care's NaturaLyte dialysate has been associated with increased risk of sudden cardiac death by causing metabolic alkalosis from its acetate content based on retrospective data using pre-dialysis bicarbonate levels only. The study objective was to measure inter/intra-dialytic changes in serum bicarbonate and degree of alkalosis conferred by varying concentrations of NaturaLyte bicarbonate dialysate. Thirty-nine hemodialysis patients were divided into four groups based on prescribed bicarbonate dialysate concentrations; Group 1 (N = 9): 30-32 mEq/L, Group 2 (N = 5): 33-34 mEq/L, Group 3 (N = 10): 35-36 mEq/L, Group 4 (N = 15): 37-40 mEq/L. Serial (pre-dialysis, immediate post-dialysis, 2 h post-dialysis, and 68 h post-dialysis) bicarbonate levels were measured. Mean pre-dialysis serum bicarbonate levels (representing 44 h post-dialysis levels) in all four groups were not statistically different. Pre-dialysis and 68 h post-dialysis bicarbonate levels in each group were also not significantly different. However, immediate post-dialysis and 2 h post-dialysis bicarbonate levels were significantly increased in all four groups proportional to dialysate dose. There was statistically significant inter-group bicarbonate level difference (P < 0.05) except between the first and second (P = 0.43) and second and third (P = 0.07) groups in the immediate post-dialysis period. Similar results were obtained for the 2 h post-dialysis period. High bicarbonate dialysate causes large and rapid fluctuations in serum bicarbonate levels during the intra/inter-dialytic period, which returns to baseline within 44 to 68 h after dialysis. This refutes the necessity to correct pre-dialysis acidosis with high bicarbonate dialysate since rapid equilibration is likely to occur and unnecessarily exposes patients to large shifts in their acid base balance.
根据仅使用透析前碳酸氢盐水平的回顾性数据，费森尤斯医疗保健公司的NaturaLyte透析液因其醋酸盐含量导致代谢性碱中毒，与心脏性猝死风险增加有关。该研究的目的是测量不同浓度的NaturaLyte碳酸氢盐透析液所导致的血清碳酸氢盐在透析期间/透析内的变化以及碱中毒程度。39名血液透析患者根据规定的碳酸氢盐透析液浓度分为四组；第1组（N = 9）：30 - 32 mEq/L，第2组（N = 5）：33 - 34 mEq/L，第3组（N = 10）：35 - 36 mEq/L，第4组（N = 15）：37 - 40 mEq/L。测量了连续（透析前、透析后即刻、透析后2小时和透析后68小时）的碳酸氢盐水平。所有四组的平均透析前血清碳酸氢盐水平（代表透析后44小时水平）无统计学差异。每组透析前和透析后68小时的碳酸氢盐水平也无显著差异。然而，所有四组透析后即刻和透析后2小时的碳酸氢盐水平与透析液剂量成比例显著升高。除了透析后即刻第一组和第二组（P = 0.43）以及第二组和第三组（P = 0.07）之间，组间碳酸氢盐水平存在统计学显著差异（P < 0.05）。透析后2小时期间也获得了类似结果。高碳酸氢盐透析液在透析期间/透析内会导致血清碳酸氢盐水平出现大幅快速波动，透析后44至68小时内会恢复到基线水平。这反驳了使用高碳酸氢盐透析液纠正透析前酸中毒的必要性，因为可能会迅速达到平衡，且不必要地使患者的酸碱平衡发生大幅变化。
