Abstract
To evaluate the acid-base status and plasma acetate levels of children undergoing hemodialysis, we studied 8 children during 11 hemodialysis sessions. During dialysis, the blood bicarbonate fell (20.5±0.7 to 19.6±0.8 mEq/L), the pCO2 fell (33.4±0.8 to 27.5±1.4 mm Hg), and the pH rose (7.42±0.01 to 7.48±0.02). During the hour after dialysis the bicarbonate rose to normal, 23.4±9.7 mEq/L, the pC02 rose to 32.8±0.8 mm Hg, and the pH remained unchanged. The half-life of plasma acetate, measured after dialysis, was 8.7±0.9 minutes. During 5 “high efficiency” dialysis sessions (urea clearance>3.0 ml/min/kg) blood bicarbonate fell 3.2 mEq/L, pCO2 fell 8.7 mm Hg, and plasma acetate rose to 7.51 mM/L, whereas during 6 “routine efficiency” dialysis sessions (urea clearance 1.5 - 3.0 ml/min/kg) bicarbonate rose 1.0 mEq/L, pCO2 fell 3.7 mm Hg, and acetate rose to 3.52 mM/L. At one hour after the end of dialysis blood bicarbonate, pCO2, and plasma acetate concentrations were similar in the two groups. Clinical problems occurred more frequently in the high efficiency group during dialysis but the difference was not significant. The data indicate that 1) dialysis with acetate buffer effectively corrects pre-dialysis metabolic acidosis, 2) although children have a high rate of acetate metabolism, during high efficiency dialysis this rate is exceeded by the influx of acetate, and acid-base abnormalities occur. These abnormalities are transient but may cause clinical problems.
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Kaiser, B., Potter, D., Bryant, R. et al. ACID-BASE CHANGES AND ACETATE METABOLISM DURING ROUTINE AND HIGH EFFICIENCY HEMODIALYSIS IN CHILDREN. Pediatr Res 14, 993 (1980). https://doi.org/10.1203/00006450-198008000-00121
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DOI: https://doi.org/10.1203/00006450-198008000-00121