Oettinger C W, Oliver J C
Emory University School of Medicine and Dialysis Clinic, Incorporated, Atlanta, GA 30308.
J Am Soc Nephrol. 1993 May;3(11):1804-7. doi: 10.1681/ASN.V3111804.
Uremic acidosis accompanies chronic renal failure in hemodialysis patients because of a retention of nonvolatile acids. Standard bicarbonate (39 mEq/L) and acetate (38 mEq/L) dialysates do not completely correct the acidosis. The acid-base and biochemical effect of a high-bicarbonate (42 mEq/L) dialysate was evaluated in 38 patients during high-efficiency and high-flux dialysis over 12 wk. All patients were dialyzed on standard bicarbonate dialysate before the study and for 8 wk after the study. In order to monitor potential excessive alkalosis, predialysis and postdialysis arterial blood gases were measured in seven patients who initially had a normal predialysis pH. Serum chemistries revealed no significant changes in predialysis BUN, calcium, ionized calcium, or phosphorus during the 12-wk study. There was no change in postdialysis ionized calcium or phosphorus. Predialysis and postdialysis serum total CO2 (STCO2) increased over the 12-wk study (P < 0.0001). By week 12, 75% of the hemodialysis patients had an STCO2 > 23 mEq/L and no patient had an STCO2 > 30 mEq/L predialysis. After the 8-wk washout, all chemistries were no different from prestudy concentrations. Predialysis blood gases in seven patients with normal predialysis HCO3 revealed a significant increase (P < 0.009) in PCO2 and HCO3 over the 12-wk study; predialysis pH and PO2 did not change. There was no significant change in postdialysis blood gases. It was concluded that: (1) a high-bicarbonate dialysate corrects predialysis acidosis in 75% of hemodialysis patients without causing progressive alkalemia, hypoxia, or hypercarbia; and (2) predialysis BUN, calcium, ionized calcium, and phosphorus are unaffected by high-bicarbonate dialysate.
由于非挥发性酸的潴留，尿毒症酸中毒伴随血液透析患者的慢性肾衰竭出现。标准碳酸氢盐（39 mEq/L）和醋酸盐（38 mEq/L）透析液不能完全纠正酸中毒。在38例患者进行为期12周的高效高通量透析期间，评估了高碳酸氢盐（42 mEq/L）透析液的酸碱及生化效应。所有患者在研究前和研究后8周均使用标准碳酸氢盐透析液进行透析。为监测潜在的过度碱中毒，对7例透析前pH值正常的患者测量了透析前和透析后的动脉血气。血清化学检查显示，在为期12周的研究期间，透析前的尿素氮、钙、离子钙或磷无显著变化。透析后的离子钙或磷也没有变化。在为期12周的研究中，透析前和透析后的血清总二氧化碳（STCO2）升高（P < 0.0001）。到第12周时，75%的血液透析患者STCO2 > 23 mEq/L，且没有患者透析前STCO2 > 30 mEq/L。经过8周的洗脱期后，所有化学指标与研究前浓度无差异。7例透析前HCO3正常的患者透析前血气显示，在为期12周的研究中PCO2和HCO3显著升高（P < 0.009）；透析前pH值和PO2没有变化。透析后的血气没有显著变化。得出的结论是：（1）高碳酸氢盐透析液可纠正75%血液透析患者的透析前酸中毒，且不会导致进行性碱血症、低氧血症或高碳酸血症；（2）透析前的尿素氮、钙、离子钙和磷不受高碳酸氢盐透析液的影响。
