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

Maccariello, Elizabeth; Rocha, Eduardo; Dalboni, Maria Aparecida; Ferreira, Alice Teixeira; Draibe, Sérgio Antônio; Cendoroglo, Miguel

doi:10.1046/j.1525-1594.2001.06895.x

Cited by 10 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, in previous years, the possibility of calcium carbonate precipitation prevented the widespread use of premixed fluid bags [8,21,22]. In our study, visual inspection was negative at all times, and no clinically significant changes in calcium or bicarbonate concentrations were noticed.…”

Section: Discussionsupporting

confidence: 44%

Purity and Stability of Online-Prepared Hemodiafiltration Fluid after Storage

et al. 2013

View full text Add to dashboard Cite

Background/Aims: Previous studies have suggested that online hemodiafiltration (OL-HDF) fluid can be used as dialysate for continuous renal replacement therapies, and thus HDF costs can be reduced. The aims of this study were to determine the purity of OL-HDF fluid and to verify the stability of the electrolyte composition and acid-base balance during its storage. Methods: OL-HDF fluid was collected in 70 individual bags and stored for up to 7 days. The following tests were performed daily in 10 bags: natural visible precipitation (macrocrystallization), sample collection for chemical analysis and fluid culture, limulus amebocyte lysate endotoxin test, standard culture of NALGENE® filters after passing of the fluid, and molecular analysis of bacterial DNA. Results: The values of pH and pCO₂ showed a significant change starting at 24 h (p < 0.001); after 72 h, their values were beyond the measurable range. Coefficient of variation for pCO₂ was as high as 25.7%. Electrolyte composition (Na⁺, K⁺, Cl^–, Ca²⁺ and glucose) showed a statistically significant difference over time (p < 0.05); however, their coefficients of variation were low (1.7, 1.4, 0.6, 2.3 and 0.9%, respectively), which might not be considered clinically significant. Negative results were obtained at all points by fluid and filter cultures, endotoxin test and molecular analysis. No macrocrystallization was observed at any time point. Conclusions: We demonstrate the microbiological purity of OL-HDF fluid stored for up to 7 days. The electrolyte composition was stable, except for a relevant change in pCO₂ and consequently in pH (first noted at 24 h), emphasizing the need to reassess the acid-base balance in multilayer plastic bags in future studies.

show abstract

Section: Discussionsupporting

confidence: 44%

Purity and Stability of Online-Prepared Hemodiafiltration Fluid after Storage

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Indeed, in our previous study, the delivered calcium concentration varied inversely with crystal precipitation. In the SB, crys‐tallization was greater and the delivered calcium was lower compared to DB (15). In addition, the test solution pH was alkaline for the bicarbonate‐buffered and acidic for the lactate‐buffered solutions.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study we have shown that when calcium and bicarbonate are mixed in the same bag, even immediately before testing, there is always a certain amount of precipitation. Consequently, the delivered dose of electrolytes and buffer is less than the prescribed dose (15). The impact of the presence of these precipitated crystals and the correlated changes in the electrolytic composition of these solutions on leukocyte function have not yet been investigated.…”

mentioning

confidence: 99%

Effects of Customized Bicarbonate Buffered Solutions for Continuous Renal Replacement Therapies on Polymorphonuclear Leukocytes Function and Viability

et al. 2004

Self Cite

View full text Add to dashboard Cite

It has previously been shown that the mixture of bicarbonate and calcium in the solutions used for continuous renal replacement therapy led to crystallization and significant changes in calcium concentration and pH. The aim of this study was to investigate the impact of bicarbonate/calcium and lactate/calcium solutions for Continuous Renal Replacement Therapies (CRRT) on the viability and function of polymorphonuclear cells (PMN). We tested four customized bicarbonate buffered solutions: single bag (bicarbonate and calcium mixed 24 h before testing), double bag (mixed immediately before testing), filtered single bag and double bag solutions, and a commercial lactate buffered solution. Blood from 6 volunteers was incubated with the solutions for 30 min followed by PMN isolation. After overnight incubation, viability, phagocytosis, and peroxide production by PMN were determined by flow cytometry. There was no difference between the test solutions with respect to PMN viability and function. Therefore, the presence of microcrystals and the consequent changes in electrolyte concentrations do not seem to impair PMN function.

show abstract

“…First, the ideal prepackaged replacement solution should include a bicarbonate buffer instead of a lactate buffer. However, precipitation of crystals has been clearly documented, even when solutions containing calcium and bicarbonate are mixed immediately prior to use (37). While the implications of this are not entirely clear, it would seem prudent at this time not to use a bicarbonate‐based buffer solution.…”

Section: Disadvantagesmentioning

confidence: 99%

DAILY HEMODIALYSIS—SELECTED TOPICS: Rationale and Experience with Short Daily Hemofiltration

Jaber

Zimmerman

2004

Seminars in Dialysis

View full text Add to dashboard Cite

Patients with end-stage renal disease (ESRD) have morbidity and mortality rates that are much higher than those found in the general population. The nonphysiologic nature of thrice-weekly hemodialysis may be partially responsible for the poor outcomes in this patient population. In response to the problems encountered with conventional hemodialysis schedules, a number of investigators have explored potential solutions to the problem. One such solution is to increase the time and/or frequency of hemodialysis. With this approach, ESRD patients have been observed to have better anemia management and blood pressure control, as well as improvements in quality of life. Hemodialysis is based on diffusion of solutes across a semipermeable membrane such that only small molecules are readily removed. Therefore a second solution has been to utilize hemofiltration instead of hemodialysis. Hemofiltration utilizes convective clearance of molecules, resulting in an improvement in the removal of larger solutes, much like the glomerular basement membrane of the kidney. Despite the accumulated evidence that thrice-weekly hemofiltration adds to the benefits seen with increasing hemodialysis time and/or frequency, the use of hemofiltration has been limited by the available technology, cost, and low access blood flows. However, current technological advances in equipment and access creation are addressing these problems. With these advances, a number of investigators have also explored the potential benefits of daily hemofiltration as a treatment option for ESRD. The preliminary results suggest that improvements in blood pressure, beta2-microglobulin (beta2M) levels, and quality of life are possible.

show abstract

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

Cited by 10 publications

References 19 publications

Purity and Stability of Online-Prepared Hemodiafiltration Fluid after Storage

Purity and Stability of Online-Prepared Hemodiafiltration Fluid after Storage

Effects of Customized Bicarbonate Buffered Solutions for Continuous Renal Replacement Therapies on Polymorphonuclear Leukocytes Function and Viability

DAILY HEMODIALYSIS—SELECTED TOPICS: Rationale and Experience with Short Daily Hemofiltration

Contact Info

Product

Resources

About