Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Department of Medicine, Zuckerberg San Francisco General Hospital and the University of California in San Francisco School of Medicine, San Francisco, California, USA.
Artif Organs. 2021 Dec;45(12):1576-1581. doi: 10.1111/aor.14083. Epub 2021 Oct 21.
Hemodialysis corrects metabolic acidosis by transferring bicarbonate or bicarbonate equivalents across the dialysis membrane from the dialysis fluid to the plasma. With the conventional three-stream bicarbonate-based dialysis fluid delivery system, a change in the bicarbonate concentration results in changes in the other electrolytes. In practice, the dialysis machine draws either a little less or more from the bicarbonate concentrate and a little more or less from the acid concentrate, respectively in a three-stream delivery system. The result not only changes the bicarbonate concentration of the final dialysis fluid but also causes a minor change in the other ingredients.
We propose a four-stream bicarbonate-based dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a product water, and a new sodium chloride concentrate.
By adjusting the flow rate ratio between the sodium chloride and sodium bicarbonate concentrates, one can achieve the desired bicarbonate concentration in the dialysis fluid without changing the concentration of sodium or ingredients in the acid concentrate. The chloride concentration mirrors the change in bicarbonate but in the opposite direction.
A four-stream, bicarbonate-based dialysis fluid delivery system allows the bicarbonate concentration to be changed without changing the other constituents of the final dialysis fluid.
血液透析通过将碳酸氢盐或碳酸氢盐当量从透析液转移到血浆中，从而纠正代谢性酸中毒。在传统的三管碳酸氢盐基透析液输送系统中，碳酸氢盐浓度的变化会导致其他电解质的变化。实际上，在三管输送系统中，透析机会分别从碳酸氢盐浓缩液中抽取稍多或稍少的量，而从酸浓缩液中抽取稍多或稍少的量。其结果不仅改变了最终透析液中的碳酸氢盐浓度，而且还导致其他成分发生微小变化。
我们提出了一种四管碳酸氢盐基透析液输送系统，该系统由酸浓缩液、碱浓缩液、产品水和新的氯化钠浓缩液组成。
通过调整氯化钠和碳酸氢钠浓缩液之间的流速比，可以在不改变酸浓缩液中钠或成分浓度的情况下，将透析液中的碳酸氢盐浓度调整到所需水平。氯离子浓度与碳酸氢盐的变化相反。
四管碳酸氢盐基透析液输送系统允许改变碳酸氢盐浓度而不改变最终透析液的其他成分。
