Nephrol Dial Transplant (2003) 18: 2369-2376
© 2003 European Renal Association-European Dialysis and Transplant Association
Original Article
Unexpected haemodynamic instability associated with standard bicarbonate haemodialysis
1Department of Nephrology and 2Department of Internal Medicine, Ospedale la Carità, Locarno and 3Department of Internal Medicine, Ospedale San Giovanni, Bellinzona, Switzerland
Correspondence and offprint requests to: Luca Gabutti, Department of Nephrology, Ospedale la Carità, Via Ospedale, 6600 Locarno, Switzerland. Email: luca.gabutti{at}eoc.ch
Background. The bicarbonate concentration in dialysis fluids for intermittent haemodialysis usually is between 32 and 35 mmol/l. The severity of chronic metabolic acidosis secondary to end-stage renal failure is very variable, however, so that in some patients pre-dialysis acidosis is overcorrected. This study aimed to analyse haemodynamic tolerances to metabolic alkalosis during intermittent haemodialysis.
Methods. In this randomized controlled trial with a single blind, cross-over design, we used dialysis liquids with two different bicarbonate concentrations, 32 (modality A) and 26 (modality B) mmol/l, and in 26 patients, 468 dialysis sessions, compared blood pressure, heart rate, incidence of hypotension and the frequency of corrections required with saline or hypertonic glucose infusions.
Results. The results of intradialytic haemodynamic monitoring for modalities A and B, respectively, were: lowest systolic blood pressure 120.8±20.8 vs 124.3±20.6 mmHg (P < 0.01); mean systolic blood pressure 138.5±23.8 vs 144.6±24.8 mmHg (P < 0.001); and highest heart rate 73.5±12.0 vs 75.8 ± 12.9 (NS); with modality A, patients had more dialysis sessions with hypotensive episodes (5.55 vs 1.7%, P < 0.05) and required more saline or hypertonic glucose infusions (20.9 vs 13.7% of the dialysis sessions, P < 0.05).
Conclusions. Mild metabolic alkalosis resulting from standard bicarbonate haemodialysis (32 mmol/l) may induce symptomatic hypotension. While normalizing chronic metabolic acidosis is desirable, reducing bicarbonate concentrations should be considered in cases of significant alkalaemia or otherwise untreatable haemodynamic instability.
Keywords: alkalosis; bicarbonate; haemodialysis; haemodynamics; hypotension
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  L. Gabutti, G. Bianchi, D. Soldini, C. Marone, and M. Burnier Haemodynamic consequences of changing bicarbonate and calcium concentrations in haemodialysis fluids Nephrol. Dial. Transplant., March 1, 2009; 24(3): 973 - 981. [Abstract] [Full Text] [PDF]
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