Acetate Hemodialysis in Children: Carbon Dioxide Removal with or without Hypoxemia if a High-Permeable Membrane Is Used

Fischbach, Michel; Hamel, G.; Meunier-Carus, J; Tarral, E.; Zita, C.; Geisert, J

doi:10.1159/000183663

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…In addition, mechanically ventilated patients in whom the minute ventilation is kept constant do not develop hypoxemia. A subgroup of children on acetate dialysis with highly permeable membranes who did not develop hypoxemia has been described (42). In this situation, the acetate-induced acidosis may have stimulated ventilation and thus prevented the decrease in Pa02.…”

Section: Membrane-independent Hypoventilationmentioning

confidence: 99%

Dialysis‐Associated Hypoxemia: Insights into Pathophysiology and Prevention

Ross

Nissenson

1988

Seminars in Dialysis

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Several excellent reviews of dialysis-associated hypoxemia (DAH) have been published (1-4). The causes, clinical manifestations, and prevention of this entity, however, are still the subjects of continuing investigation. The hypoxemia is a major concern in some patients, occumng within 15 minutes of initiation of dialysis in up to 90% of patients, decreasing the arterial oxygen tension (Pa02) from 5 to 35 mm Hg and resolving within 60-120 minutes after discontinuation of dialysis (5, 6). In addition, studies of DAH have led to new and important thoughts about blood-membrane interaction. Although many etiologies have been proposed to explain DAH, the effects of both the dialyzer membrane and the dialysate bath have received particular attention. Briefly, cellulosic dialyzer membranes (particularly Cuprophane) activate the alternative complement pathway and within minutes after contact with the blood induce Ieukoagglutination and profound neutropenia. Subsequent lung sequestration of white blood cell microaggregates causes intrapulmonary diffusion abnormalities which widen the alveolar to arterial oxygen gradient (AaDOz), causing early (5-15 minutes), modest hypoxemia. In addition, with acetate dialysate baths, more severe hypoxemia occumng somewhat later in dialysis ( 15-60 minutes) is due to compensatory hypoventilation induced by extracorporeal loss of COZY altered metabolism causing increased oxygen consumption, and possibly depression of the central respiratory center. This commentary will explore the relative pathophysiologic and clinical importance of these and other proposed mechanisms. Clinical SignificanceThe clinical manifestations of DAH are variable and to a large degree depend on the patient's underlying cardiopulmonary status. Reports of the benign effects of modest decreases in the Pa02 cannot be applied to patients with already compromised cardiac or pulmonary status who require different (albeit often more costly) dialysis strategies.

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Section: Membrane-independent Hypoventilationmentioning

confidence: 99%

Dialysis‐Associated Hypoxemia: Insights into Pathophysiology and Prevention

Ross

Nissenson

1988

Seminars in Dialysis

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“…Acetate itself may depress cardiovascular function in dogs [16][17][18] [20,53], Since acetate has an obligatory oxidative metabolism, the availability of oxy gen in muscle is also of paramount importance. Note that a reduction of arterial POj is usually observed dur ing acetate dialysis (see below), while the release of oxy gen from hemoglobin in peripheral tissues is hampered by the alkalinization of the blood (as indicated by an increment in the P 50 value) [54] or by possible changes in 2,3-DPG [55], In anemic patients, these factors may compromise optimal oxygen and acetate delivery to ace tate-metabolizing sites.…”

Section: Tissue Perfusionmentioning

confidence: 99%

Acetate Metabolism during Hemodialysis: Metabolic Considerations

et al. 1987

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Acetate is used during regular hemodialysis to replace the bicarbonate lost during dialysis. The temporal changes of plasma bicarbonate and acetate concentrations and the critical role of acetate metabolism for the maintenance of plasma bicarbonate are described. We point out that the maximal rate of acetate oxidation in man is usually reached during dialysis, and we identify physiologic and pathologic factors that may modify this V_max. A syndrome of ‘intolerance to acetate’ has been described. This syndrome is analyzed in the light of the metabolic consequences of a rapid flux of acetate oxidation in liver and muscle cells. More specifically, the effects of rapid acetate metabolism on tissue ATP, CoA, adenosine and other ATP degradation products are presented. The possible impact of dialysis-induced depletion of carnitine on optimal acetate metabolism is discussed. The potential clinical consequences produced by these changes are presented in relation to the symptoms sometimes observed during dialysis against acetate: vasodilation, hypotension and angina pectoris. The hypoxemia induced by acetate is also briefly reviewed. Different directions are proposed for future research.

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Sequential hypertonic haemodialysis in children

1988

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Sequential hypertonic dialysis (SHD) was studied in two binephrectomized children over a period of 6 weeks. Each dialysis session comprised four periods of 45 min. The concentration of sodium in the dialysate [Na(D)] during the first period was 190 mmol/l and during the second period 140 mmol/l. The sequence was then repeated. The sodium-free water clearance [C(ONa)] was calculated from the measurements of the ultrafiltrate clearance and of the sodium clearance. Despite the short periods of hypertonic dialysis, C(ONa) was positive, suggesting that water was removed from the intracellular compartment as well as from the extracellular fluid. The transfer of fluid from the intracellular space improved circulatory stability during rapid removal of large volumes of fluid by ultrafiltration. SHD was also associated with increased removal of potassium and phosphate. Comparison of clinical parameters before and during SHD showed a tendency towards increased sodium balance and the possibility of raised cardiovascular morbidity. SHD stabilized blood volume during ultrafiltration, encouraging removal of uraemic toxins. SHD with this level of Na(D) is only a study dialysis method.

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Acetate Hemodialysis in Children: Carbon Dioxide Removal with or without Hypoxemia if a High-Permeable Membrane Is Used

Cited by 5 publications

References 5 publications

Dialysis‐Associated Hypoxemia: Insights into Pathophysiology and Prevention

Dialysis‐Associated Hypoxemia: Insights into Pathophysiology and Prevention

Acetate Metabolism during Hemodialysis: Metabolic Considerations

Sequential hypertonic haemodialysis in children

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