Improved effect of hemodialysis on acidemic patients from an acetate concentration of 38 mmol/l.

A high frequency of metabolic acidosis in a group of 30 patients on regular dialysis treatment initiated a study of the effect (and possible side effects) of a higher concentration of acetate in the dialysate. The concentration of acetate in the dialysate was increased from 32.6 ('low ac') to 38.2 mmol/l ('high ac'). The 'low ac' dialysis treatment changes the metabolic acidoses (mean pH = 7.34; base excess, BEb = - 8.3 mmol/l) to chronic hypocapnia (pH = 7.40; BEb = - 5.4 mmol/l). 'High ac' normalized the acid base status (pH = 7.44; BEb = -0.6 mmol/l). No side effects occurred. Since PaCO2 does not change much during hemodialysis it is convenient to look at the linearly related changes of the pH and the logarithmic standard bicarbonate concentration along iso-PCO2 lines in a log standard bicarbonate-pH-nomogram.