부산대학교 도서관

Correction of metabolic acidosis in chronic renal failure is one f the main goals of hemodialysis replacement therapy. Dialysis produces changes in the main anions of intermediary metabolism related to modality and the liquid used. A prospective crossover study was carried out with 22 stable patients on dialysis. who were assigned to start sessions of standard hemodiafiltration with bicarbonate 34 mmol/L and acetate dialysate 3 mmol/L or biofiltration without acetate (AFB). According to acid-base balance classic approach patients significantly increased pH and bicarbonate during the sessions of both modalities. We only note a slight decrease in the pH determination made thirty minutes postdialysis in AFB. According Stewart-Fencl physical-chemical approach apparent strong ionic difference (SIDa) decreased because of a lower Cl- than strong cations loss on hemodiafiltration and effective strong ionic difference ( SIDe) rised in both modalities. Strong ionic hiatus (SIG) decreased at the end of dialysis. Acetate increased significantly during the HDF session from 0.078 ± 0.062 mmol /l to 0,156 ± 0,128 mmol / l (p <0.001) and remained unchanged at 0.044 ± 0.034 mmol and 0,055 ± 0.028 mmol / l in AFB. There were differences in the acetate levels in the beginning, two hours, at the end and thirty minutes after the session between HDF and AFB (p <0.005, p <0.005 and p <0.05). Concentrations of serum lactate and pyruvate decreased during the sessions without differences between modalities. Citrate decreased only in AFB (p <0.05). Acetoacetate increased in both modalities. Betahydroxybutyrate rose significantly in both groups, but the highest values were detected in AFB (p <0.05). Estimation of the anions involved in the etiology of metabolic acidosis, gap anion (GA) and corrected albumin and phosphate GA (CGA) and strong ion hiatus or SIG and the indeterminate anions of the SIG (UA) decreased during the both modalities session and remained unchanged after the session. It was observed correlation between the SIG and CGA in all studied times. Inorganic anions such as sulfate and phosphate decreased during both dialysis modalities Dialysis efficacy parameters, PCR and the generation of H + showed similar results between the two techniques. The sum of measured organic anions (OA) increased in both modalities. Postdialysis levels were higher in HDF 0.77 ± 0.36 mmol / l compared to AFB 0.48 ± 0.18 mmol / l (p <0.05). AFB provides an optimal correction of acid-base equilibrium through a suitable infusion fluid with base gaining and it is able to achieve adequate control of certain metabolic aspects. It prevents chronic hyperacetatemia and restore internal homeostasis with less activation of intermediary metabolism.