Ramos J M, Muirhead N, Laker M F, Ward M K, Kerr D N
Nephrologie. 1983;4(4-5):231-5.
Leucocyte count, blood pH and gases, plasma concentrations of total and ionised calcium, of phosphate and PTH were studied in 11 stable patients on chronic haemodialysis alternatively, the sequence being randomised, during acetate (AHD) and bicarbonate (BHD). Initial leucopenia and its subsequent correction were comparable with both dialysis types whereas pO2 and pCO2 transitory decreased only in AHD so that the mechanism of hypoxemia with AHD does not seem to be related to the pulmonary leucostatis but rather to the reflex hypoventilation secondary to the decrease of pCO2 into the acetate dialysis. As regards the bone metabolism, no difference was observed between HDA and HDB considering the increase of total and ionised calcium, the decrease of plasma phosphate and the absence of decrease of PTH, the initial levels of which being however only slightly elevated. However blood pH was significantly (but slightly) higher before the subsequent dialysis in the case of BHD. This more sustained correction of acidosis would be the only theoretical advantage of BHD for the prevention of bone demineralisation.
