Abstract
Sodium acetate has been used as a substitute for sodium bicarbonate in dialysate solution. However, several reports have suggested that sodium acetate has a depressant action on the cardiovascular system.
In this study, hemodynamic change during five hours hemodialysis was invasively evaluated by a method of left and right heart catheterization in four patients, especially on left ventricular contractility, total peripheral resistance index (TPRI) and their interactions with blood sodium acetate. We adopted max dp/at and max dp/dt/p as indices of the contractility.
At the onset of hypotension with or without untoward symptoms such as yawning, nausea and vomiting, the contractility was depressed with concomittant reductions in cardiac index (C. I.), mean blood pressure (BP) and TPRI. After rapid infusion, the depressed contractility was improved with marked elevations in C. I. and BP. Even during asymptomatic study periods, the contractility might be depressed or enhanuced.
Blood samples for the determination of acetate level were obtained from four sites such as shunt, left ventricle, pulmonary artery and right atrium. The level in shunt was closely identical with those in left ventricle as well as in pulmonary artery. However, in right atrium, it was approximately a half of the level.
Each contractility parameter described above and TPRI were statistically compared with blood acetate levels in all sites. However, no better corelations were found in all. Consequently, it was speculated that cardiovascular depression was unrelated to blood acetate level.
