[Effect of the acid-base status on circulatory stability during acetate and bicarbonate hemodialysis].

In the preceding circulatory studies (Hampl et al. 1977, Hampl et al. 1978, Hampl et al. 1979, Hampl et al. 1980) we have proved in our patients that during the acetate dialysis (HDA) the circulatory insufficiency results from the inadequate response of the total peripheral vascular resistance (TPR) to the deprivation of the volume. Of these previously studied patients we selected six ones with frequency episodes of symptomatic hypotension during HDA, treated them with bicarbonate dialysis (HDB) and found a good tolerance to the treatment without symptomatic hypotension despite the same deprivation of the volume. We examined invasively the parameters of the circulation during HDB and found in all six patients a stability of the circulation due to the significant increase of the TPR. In addition to this we examined in the intraindividual comparison the arterial acid-base-status with simultaneous measurement of blood pressure and heart frequency in the six patients during five treatments each with HDA and HDB. Arterial PCO2, base excess and standard bicarbonate were significantly higher during HBL compared with HDA. On the other hand under HDB we did not find any significant PO2, O2-saturation and pH values lasting during the period of treatment. We concluded that the adequate adaptation of the vascular TPR to the deprivation of the volume during HDB is to be referred to a sufficient correlation of the metabolic acidosis; in particular to the normalisation of the arterial PCO2.