pO₂ and pCO₂ Increment in Post‐dialyzer Blood: The Role of Dialysate

Abstract

Blood returning from a dialyzer during hemodialysis has a higher pO2 and pCO2 content than blood entering the dialyzer, and this has been attributed to the dialysate. The present study investigates this phenomenon. Acid-base and blood-gas parameters (pH, pO2, pCO2 and HCO3) were measured in three groups of stable chronic hemodialysis patients (A, B, and C) undergoing high-flux hemodialysis. In group A (n = 15), "arterial" (a) and "venous" (v) samples were withdrawn simultaneously before dialysis (samples A0), 5 min after circulation of the blood with the dialysate in the by-pass mode (samples A5), and 5 min after high-flux hemodialysis at a zero ultrafiltration rate (samples A10). In group B (n = 11) (a) and (v) samples were withdrawn simultaneously before dialysis (samples B0), 5 min after isolated-ultrafiltration with closed dialysate ports ("isolated-closed" ultrafiltration) (samples B5), and 5 min after high-flux hemodialysis at a zero ultrafiltration rate (samples B10). In group C (n = 14), after an initial arterial blood sample withdrawal before hemodialysis (sample C0), high-flux hemodialysis at a zero ultrafiltration rate was initiated. Five minutes later, blood and dialysate samples were withdrawn simultaneously from the hemodialysis lines (samples C5). In all cases blood and dialysate (bicarbonate) flow rates were set at 0.300 and 0.700 L/min, respectively. FLX-18 hemodialyzers (membrane PEPA 1.8 m2) were used in this study. Analysis of variance revealed significant changes only in venous samples. A comparison of arterial and venous samples revealed no differences between groups A and B before the initiation of dialysis (A0a vs. A0v and B0a vs. B0v, P = NS). The pO2 content was higher in A5v samples than in A5a samples (83.5 +/- 11.2 vs. 88.8 +/- 14.0 mm Hg, P < 0.02), while the level of HCO(3) was higher in A5a samples than in A5v samples (20.8 +/- 2.0 vs. 20.4 +/- 1.8 mEq/L, P < 0.05). A10a samples possessed a higher pH and lower levels of pO2, pCO2, and HCO3 in comparison to A10v samples (P < 0.001 for all). Mean pO2 and pCO2 values in A5v and A10v samples increased by 6.3% and 12.1% and by 1.29% and 52% in comparison to corresponding values of A5a and A10a samples, respectively. The pO2 level was the only parameter that differed significantly between B5a and B5v samples (B5a = 84.6 +/- 10.1 vs. B5v = 98.0 +/- 12.6 mm Hg, P < 0.005). B10a samples possessed a higher pH and lower levels of pCO2, pO2, and HCO3 in comparison to B10v samples (P < 0.0005 for all comparisons). Mean pO2 and pCO2 values in B5v and B10v samples increased by 16.2% and 16.3% and by -0.29% and 64.8% in comparison to corresponding values of B5a and B10a samples, respectively. C5a samples possessed a higher pH and lower levels of pCO2, pO2, and HCO3 in comparison to C5v samples (P < 0.001 for all). Mean pO2 and pCO2 values in C5v samples were, respectively, 16.0% and 65.0% higher than corresponding values of C5a samples. These results indicate that blood returning from the dialyzer after 5 min of high-flux hemodialysis has a higher...

pCO₂ Reveals Arteriovenous Fistula Recirculation in Bicarbonate Hemodialysis (RecirCO₂lation Test)

“…We chose a time of 5 min from the beginning of the HD session because such period is long enough to have a significant difference in BGA parameters between blood entering the filter and blood leaving the filter [23,24] .…”

“…Our working hypothesis arises from the observation that, during the bicarbonate HD, the blood returning from the dialyzer has significantly higher carbon dioxide partial pressure (pCO 2 ) than the blood entering the dialyzer, due to the transfer from the dialysate [9,23] . Therefore, in the presence of VAR, the postdialyzer 'venous' blood with high pCO 2 , rather than returning to the systemic circulation, reenters the extracorporeal circuit through the arterial needle, increasing abnormally the value of pCO 2 in the arterial line (AL; fig.…”

Dialysis-Related Acidemia and Acidosis by Dialysate: The Forgotten Issue of CO₂ Overload from Dialysate

“…After mixing of the acid concentrate with the bicarbonate-containing solution, the pCO 2 in the dialysate ranges between 80 and 100 mm Hg [3,6,7], whereas arterial pCO 2 commonly is below 40 mm Hg (as a result of the ventilatory response to the metabolic acidosis in kidney failure). This leads to high CO 2 dialysance and thus to a sizable increase in pCO 2 in rial line is due to CO 2 load from dialysate overcoming CO 2 removal by the lung.…”

“…There is another circumstance of hypercapnia featured by normal oxygenation and lung function. This non-hypoxic hypercapnic acidemia may be called 'dialysisrelated acidemia' [2][3][4] .…”

“…blood returning to the patient [2][3][4]8] . This hypercapnia lowers pH despite high bicarbonate concentration but without hypoxia, unless lung disease coexists.…”