Continuous Venovenous Hemofiltration in Acute Renal Failure: Is a Bicarbonate- or Lactate-Buffered Substitution Better?

Customized Bicarbonate Buffered Dialysate and Replacement Solutions for Continuous Renal Replacement Therapies: Effect of Crystallization on the Measured Levels of Electrolytes and Buffer

“…Two major issues arise from the results of this study: the discrepancy between the prescribed and the final delivered dose of electrolytes and buffer and the potentially harmful effects of the infusion of crystals, especially when those solutions are infused intravenously as replacement fluids for CRRT (18,21). The relevance of these issues has been neglected by different groups that have recently reported the use of bicarbonate buffered solutions containing calcium as replacement fluids for CRRT (4,10,11–13,15,17). This is probably a result of the information obtained from past studies with open batch systems (5–7).…”

The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure

“…Lactate buffer and acetate buffer, in particular, have been shown to exert a negative influence on mean arterial blood pressure and cardiac function [4]. The problems of worsening lactic acidemia in patients with severe circulatory failure and hepatic dysfunction who are hemofiltered using the commercially available lactate-buffered replacement fluids are now well recognized [8,18,19,20].…”

Acid-Base and Electrolyte Management in Continuous Renal Replacement Therapy

“…A recently completed multicenter study in Germany has further shown that use of lactate-based substitution fluids is associated with reduced hemodynamic stability in comparison to bicarbonate-based solutions [16]. These authors also demonstrated an increase in nitrogen generation possibly related to increased catabolism in patients given lactate-based solutions [17]. These findings are similar to those of Olbricht et al [18] suggesting that lactate-based solutions may have some deleterious effects.…”

“…Hospal Hemosol, Baxter Hemofiltration Solution), which have predetermined concentrations of base (usually lactate) and ions; however, in many instances customized solutions with varying composition need to be made [7][8][9][10][11][12][13][14][15][16][17] (table 2). The choice of base in the replacement solution and dialysate is a major factor influencing acidbase balance.…”