Abstract
The use of acetate as an alkalizing agent in the dialysate solution solves the problem of precipitation of calcium and magnecium salts in the bicarbonate containing solution. However, with the development of a high-performance dialyzer, the following adverse effects of acetate dialiysis have become obvious:
1) Acetate overloading on the patients.
2) Pharmachological effect of acetate on the cardiovascular system.
3) Decrease in blood Po2 induced by the loss of CO2 through the dialyzer.
4) Inaccurate correction of acid-base balance.
5) Acetate influence on lipid metabolism.
6) Acetate influence on calcium matabolism.
The incidence of hemodialysis related symptoms was significantly reduced in bicarbonate dialysis compared with acetate dialysis.
In order to prevent precipitation of calcium and magnecium salts, pH of the solution should be kept stable by controlling PCO2. Since the recent development of the device has succeeded in supplying the stable bicarbonate dialysate, bicarbonate dialysis has become a more suitable therapy for the cases of acetate intolerance, cardiovascular complications, severe complications in maintenance hemodialysis, introduction to hemodialysis and short time dialysis with a large surface dialyzer. When acetate dialysis was changed to bicarbonate dialysis, clinical data in those patients showed obvious improvement.
