Abstract
Interest has been shown in the use of bicarbonate in place of acetate and higher sodium concentration in the dialysate over the past few years.
This study was undertaken for the purpose of performing bicarbonate and higher Na dialysis with a sorbent regenerative system (REDY system) without the need for additional equipment.
Dialysis using the bicarbonate dialysate prescribed by us was performed on 10 patients by the REDY system. A conventional dialysis using acetate dialysate was performed by the same system on each patient for comparison.
The dialysates were tested for sodium, pH, bicarbonate, partial pressure of carbon dioxide and oxygen, osmolality and aluminum. Blood samples were taken before and after dialysis and tested for blood gas, electrolytes and routine biochemicals and aluminum.
The dialysate Na fell during titration but rose during dialysis. The dialysate pH was significantly higher throughout dialysis in the bicarbonate-higher Na dialysis. The dialysate bicarbonate and osmolality fell during titration and by one hour after thje beginning of dialysis, but rose thereafter.
The blood pH, bicarbonate and base excess rose significantly by the end of bicarbonate-higher Na dialysis.
The time-averaged aluminum concentration in the bicarbonate dialysate ranged from 2-15mcg/L, whereas in the acetate dialysate it showed a progressive rise during dialysis. The post-dialysis serum aluminum concentration was higher than the pre-dialysis value in both methods of dialysis.
We conclude that the sorbent regenerative system is well suited to performing bicarbonate-higher Na dialysis owing to its unique chemistry. As for aluminum kinetics in this system, long-term investigation is necessary.
