Wehle B, Asaba H, Castenfors J, Fürst P, Grahn A, Gunnarsson B, Shaldon S, Bergström J
Clin Nephrol. 1978 Aug;10(2):62-6.
To elucidate the relative role of osmolar (sodium) and acetate shifts during dialysis, 6 patients with problems of overhydration underwent rapid ultrafiltration for 1 hr (mean weight reduction 2.0 kg), using the 1 m2 RP 6 dialyzer. Ultrafiltration was carried out at the beginning of each of 5 dialysis treatments at weekly intervals. Ultrafiltration was undertaken without dialysis (controls) and with simultaneous dialysis using acetate (40 mmoles/1) or bicarbonate (25 mmoles/1) in the dialysis fluid with dialyzate sodium concentration of 133 and 145 mmoles/1. The systolic blood pressure and mean arterial pressure which were stable with ultrafiltration only fell slightly when a high dialyzate sodium concentration was used and much further when the dialyzate sodium concentration was kept low. These changes were apparently related to the changes in plasma osmolality. Acetate had no effect on blood pressure at the higher sodium concentration, but a slight (insignificant) additive effect when used in the low-sodium dialyzate. Shifts in osmolality (sodium concentration) seem to be more important than the effect of acetate in inducing dialysis-associated hypotension.
为阐明透析过程中渗透压（钠）和醋酸盐变化的相对作用，6例存在水合过度问题的患者使用1m²的RP 6透析器进行了1小时的快速超滤（平均体重减轻2.0kg）。在每周一次的5次透析治疗开始时进行超滤。超滤在未透析（对照组）以及使用醋酸盐（40mmol/L）或碳酸氢盐（25mmol/L）同时透析的情况下进行，透析液中透析钠浓度分别为133mmol/L和145mmol/L。仅超滤时稳定的收缩压和平均动脉压，在使用高透析钠浓度时仅略有下降，而在透析钠浓度保持较低时下降幅度更大。这些变化显然与血浆渗透压的变化有关。在较高钠浓度时醋酸盐对血压无影响，但在低钠透析液中使用时有轻微（不显著）的叠加作用。渗透压（钠浓度）的变化似乎比醋酸盐在诱发透析相关性低血压方面的作用更为重要。
