Velez R L, Woodard T D, Henrich W L
Kidney Int. 1984 Jul;26(1):59-65. doi: 10.1038/ki.1984.134.
To test the contribution of bicarbonate (Bi) to hemodynamic stability during hemodialysis (HD), we compared the effects of ultrafiltration dialysis with bicarbonate and with acetate under conditions of high-sodium (141 mEq/liter) and low-sodium (130 mEq/liter) dialysate concentrations in 12 stable HD patients. Group 1 was patients (N = 5) who had normal findings on autonomic testing; group 2, patients (N = 7) who had abnormal findings on autonomic testing. All patients and staff were unaware of which dialysis was being used. During the high-sodium dialysate studies, changes in mean blood pressure (MBP), cardiac output (CO), and orthostatic tolerance to standing after HD were similar in both groups of patients with both acetate and bicarbonate dialysate. When the studies were repeated under low-sodium dialysate conditions, several differences emerged between acetate and bicarbonate HD. In group 1, the frequency of adverse symptoms upon standing after HD were reduced with bicarbonate (P less than 0.05). In group 2, bicarbonate HD prevented a significant decrease in orthostatic MBP after HD. These results suggest that bicarbonate affords no greater hemodynamic stability than does acetate if a dialysate sodium of 141 mEq/liter is used. With lower sodium dialysate, bicarbonate appears to provide a modest improvement in decreasing orthostatic symptoms and signs in patients with and without autonomic insufficiency.
为了测试碳酸氢盐（Bi）在血液透析（HD）期间对血流动力学稳定性的作用，我们比较了在高钠（141 mEq/升）和低钠（130 mEq/升）透析液浓度条件下，12例稳定的HD患者使用碳酸氢盐和醋酸盐进行超滤透析的效果。第1组为自主神经测试结果正常的患者（N = 5）；第2组为自主神经测试结果异常的患者（N = 7）。所有患者和工作人员均不知道正在使用哪种透析方式。在高钠透析液研究中，醋酸盐和碳酸氢盐透析液的两组患者在HD后平均血压（MBP）、心输出量（CO）以及站立时的直立耐受性变化相似。当在低钠透析液条件下重复研究时，醋酸盐和碳酸氢盐HD之间出现了一些差异。在第1组中，HD后站立时不良症状的发生率用碳酸氢盐时降低（P小于0.05）。在第2组中，碳酸氢盐HD可防止HD后直立MBP的显著下降。这些结果表明，如果使用141 mEq/升的透析液钠，碳酸氢盐提供的血流动力学稳定性并不比醋酸盐更好。使用较低钠透析液时，碳酸氢盐似乎能适度改善有或无自主神经功能不全患者的直立症状和体征。
