Abstract
The effect of acetate infusion on systemic hemodynamics under extracorporeal circulation using standard hemodialysis elements without dialysate supply were studied in 25 maintenance hemodialysis patients. Although the infusion of normal saline did not change any parameter of hemodynamics, TPR was decreased by acetate infusion showing a negative correlation between the ratio of change in TPR and serum acetate concentration. MBP was maintained constant due to the compensatory increase in cardiac output. The change in hemodynamics by bicarbonate infusion was similar but smaller compared to that by acetate infusion. The patients were classified into three groups according to their TPR responce to acetate and bicarbonate infusion: no change in TPR to both agents (Group I), decrease in TPR to both agents (Group II) and decrease in TPR to acetate and no change in TPR to bicarbonate (Group III). TPR responce to both agents seemed depend on basal vascular tone. Group I had the lowest basal vascular tone while Group II showed the highest basal vascular tone. Group III indicated modarate basal vascular tone. Accordingly, the higher the basal vascular tone was, the larger decrease in TPR was found in responce to vasodilators.
When the patients were classified into acetate tolerance and intolerance groups to study the effect of acetate loading, no difference was detected between the two groups except serum level of acetate 30min after acetate infusion, suggesting that acetate metabolism of the acetate intolerance group was somewhat impaired resulting in hyperacetemia with various side effects in acetate dialysis.
