Clinical Investigation

Kidney International (1985) 27, 768–773; doi:10.1038/ki.1985.78

Comparative effects of acetate and bicarbonate hemodialysis on left ventricular function

Michael A Ruder1, Martin A Alpert1, John Van Stone1, Mathew R Selmon1, Diana L Kelly1, James D Haynie1 and Sharon K Perkins1

1Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA

Correspondence: Dr M A Alpert, Division of Cardiology, University of Missouri Health Sciences Center, One Hospital Drive, Room 1E-65, Columbia, Missouri 65212, USA

Received 28 February 1984; Revised 30 October 1984.

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Abstract

Comparative effects of acetate and bicarbonate hemodialysis on left ventricular function. To assess the comparative effects of hemodialysis with acetate versus bicarbonate base on left ventricular systolic function, we performed M-mode echocardiography on 36 patients prior to and immediately following 4-hr maintenance hemodialysis. Patients were initially dialyzed against either sodium acetate or sodium bicarbonate and 1 week later were dialyzed against the alternate base. The mean velocity of circumferential fiber shortening (mean Vcf, circumferences/s) was used to assess left ventricular systolic function. In patients with normal pre-dialysis mean Vcf hemodialysis with acetate produced no significant change in mean Vcf, whereas hemodialysis with bicarbonate produced a significant increase in mean Vcf. In patients with low pre-dialysis mean Vcf hemodialysis with either base produced a significant increase in mean Vcf. Mean Vcf values obtained after hemodialysis with bicarbonate were significantly higher than those obtained after hemodialysis with acetate, both in patients with normal and low pre-hemodialysis mean Vcf. We conclude that hemodialysis with bicarbonate produces a comparatively greater improvement in left ventricular systolic function than hemodialysis with acetate.

Effets comparatifs de l'hémodialyse en acétate ou en bicarbonate sur la fonction ventriculaire gauche. Afin de préciser les effets comparés de T hémodialyse en base acétate par rapport à une base bicarbonate sur la fonction systolique ventriculaire gauche, nous avons fait des échocardiographies en mode M chez 36 malades avant et immédiatement après une hémodialyse de quatre heures. Les malades étaient d'abord dialyses contre de l'acétate de sodium ou contre du bicarbonate de sodium et une semaine plus tard étaient dialyses contre l'autre base. La vitesse moyenne de raccourcissement des fibres circonférentielles (Vcf moyenne, circonférences/s) a été utilisée pour aprécier la fonction systolique ventriculaire gauche. Chez les malades ayant une Vcf moyenne pré-dialytique normale, l'hémodialyse avec acétate n'a entraîné aucune modification significative de Vcf moyenne, tandis que l'hémodialyse avec bicarbonate a augmenté significativement la Vcf moyenne. Chez les malades ayant une faible Vcf moyenne avant dialyse, l'hémodialyse avec une des deux bases a significativement accru la Vcf moyenne. Les valeurs de Vcf moyenne obtenues après hémodialyse avec bicarbonate étaient significativement plus hautes que celles obtenues après hémodialyse avec acétate, chez les malades avec Vcf moyenne normale ou basse avant dialyse. Nous concluons que l'hémodialyse avec bicarbonate entraîne une amélioration comparativement plus grande de la fonction systolique ventriculaire gauche que l'hémodialyse avec acétate.

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