Scheppach W, Kortmann B, Burghardt W, Keller F, Kasper H, Bahner U, Teschner M, Heidland A
Department of Medicine, Würzburg University, FRG.
Clin Nephrol. 1988 Jan;29(1):19-27.
The utilization of acetate and its effects on acid-base balance and on free fatty acid metabolism were investigated during regular hemodialysis (HD). Fourteen patients with chronic renal failure were studied during two successive dialysis treatments for which either acetate or bicarbonate were used as a buffer anion in the dialysate. In the acetate studies the mean plasma acetate concentration in the arterial line rose from 0.16 mM to 4.67 mM, while it rose from 0.17 mM to 0.62 mM during bicarbonate dialysis. There was a linear relationship between acetate utilization and the acetate concentration in the venous line. The increase of the blood pH during bicarbonate HD was due to an immediate increase of HCO3, whereas acetate caused a smaller HCO3 rise and a pronounced fall of the pCO2. The heart rate was higher during acetate than during bicarbonate HD. During both types of dialysis there was a twofold rise of total FFA as well as the individual fatty acids palmitate, palmitoleate, oleate, stearate and linoleate which was of similar magnitude when acetate or bicarbonate were used. The postulated antilipolytic effect of the short-chain fatty acid acetate could not be demonstrated under the circumstances of routine hemodialysis. Pre-dialysis dopamine was elevated in 7 of the 11 patients and remained high during both types of HD; other hormones were normal during acetate and bicarbonate HD.
在常规血液透析（HD）期间，对醋酸盐的利用及其对酸碱平衡和游离脂肪酸代谢的影响进行了研究。对14例慢性肾衰竭患者在连续两次透析治疗期间进行了研究，透析液中分别使用醋酸盐或碳酸氢盐作为缓冲阴离子。在醋酸盐研究中，动脉管路中的平均血浆醋酸盐浓度从0.16 mM升至4.67 mM，而在碳酸氢盐透析期间从0.17 mM升至0.62 mM。醋酸盐的利用与静脉管路中醋酸盐浓度之间存在线性关系。碳酸氢盐血液透析期间血液pH值的升高是由于HCO3立即增加，而醋酸盐导致HCO3升高较小且pCO2明显下降。醋酸盐透析期间的心率高于碳酸氢盐透析期间。在两种类型的透析过程中，总游离脂肪酸以及个别脂肪酸棕榈酸、棕榈油酸、油酸、硬脂酸和亚油酸均增加了两倍，使用醋酸盐或碳酸氢盐时增加幅度相似。在常规血液透析情况下，短链脂肪酸醋酸盐假定的抗脂解作用未得到证实。11例患者中有7例透析前多巴胺升高，且在两种类型的血液透析期间均保持较高水平；在醋酸盐和碳酸氢盐血液透析期间，其他激素均正常。
