The influence of acetate versus bicarbonate on patient symptomatology during dialysis.

The effect of large-surface area dialysis (LS) using dialysate containing both acetate and bicarbonate (LS-C) on a patient's symptomatology was compared with that noted with acetate (LS-A) or bicarbonate (LS-B) in the dialysis fluid. Patients experienced significantly more symptoms and deterioration of objective performance test scores with both LS-A and LS-C than LS-B. Furthermore, a correlation was seen between plasma acetate level at the end of dialysis and decrement in the performance test scores. The results suggest that accumulation of acetate rather than acute alteration in acid-base status is primarily responsible for the morbidity.