Abstract
Some of the dialysis patients show frequent hypotensive episodes and shock state. Including dysequilibrium syndrome, this intolerance is at present summarized as “dysdialysis syndrome”.
In present study, typical cases of this dysdialysis syndorome were studied if bicarbonate-high sodium dialysate could improve the syndorome. The patients were subjected to sequential phases of four weeks of high sodium (150mEq/l) acetate (35mEq/l) dialysis (HS-A), four weeks of high sodium (150mEq/l) bicarbonate (30mEq/l) dialysis (HS-BI) and four weeks of high sodium (160mEq/l) bicarbonate (30mEq/l) dialysis (HS-B2). Dialysis was done on thrice weekly basis with duration of 5 hours. To prevent severe thirst, sodium concentration was changed to 130mEq/l in the last one hour of each treatment. Dialysate supplyers were BN-11® (Nikkiso). Bicarbonate Infuser was NS-1® (Nipro). Blood pressure, body weight gain, symptoms, frequencies of saline infusion, blood electrolytes, osmolarity and blood gas were compared in those sequential dialysis regimes. Patient showed high blood acetate concentration (3.9mEq/l) and decreased of bicarbonate concentration (3.65mEq/l) after four hours: acetate dialysis were completely improved, by bicarbonate dialysate. Frequencies of hypotension in HS-A, HS-BI and HS-B2 were 83%, 41.7% and 21% respectively. Frequencies of saline infusion were 66.6%, 25% and 16.7%. Body weight gain was larger in HS-B2 than in HS-A by 0.3kg. Thus, offect of bicarbonate and high sodium dialysis showed an excellent advantage on the improvement of dysdialysis syndorome.
