Acetate metabolism and bicarbonate generation during hemodialysis: 10 years of observation

Vinay, Patrick; Prud'Homme, Michel; Vinet, Bernard; Cournoyer, Ginette; Degoulet, Patrice; Leville, Michel; Gougoux, Andrè; St-Louis, Gilles; Lapierre, Louis; Piette, Yves
May 1987
Kidney International;May1987, Vol. 31 Issue 5, p1194
Academic Journal
The capacity of chronically hemodialyzed patients to metabolize acetate during conventional hemodialysis was evaluated using a retrospective study in 219 patients dialyzed for up to ten years under similar dialysis conditions. For each patient, and using all available data, a regression line relating the changes of plasma total CO2 during dialysis as a function of the pre-dialysis value was calculated. The intercept of this function indicates the plasma concentration where the losses of bicarbonate in the dialysate is matched by the generation of bicarbonate arising from the metabolism of acetate. This value therefore represents an individual index of the capacity of each patient to metabolize acetate. A value for this index smaller than 18.0 mM was considered abnormal. It was shown that around 10% of chronically hemodialyzed patients are clearly unable to metabolize acetate optimally. This defect is not related to the duration of dialysis, body weight or quality of hemodialysis treatments but is strongly related to sex, 19 of the 22 ‘acetate intolerant’ patients being women. In a prospective study, all the 60 patients of the same population undergoing active dialysis were studied, and this index identified 12 abnormal (11 women, 1 man) patients and 48 normal patients.. Plasma acetate measured at the end their dialysis treatments were significantly higher in abnormal than in normal patients. It is concluded: 1) that this index is useful to identify the patients unable to metabolize acetate optimally: 2) that only around 10% of hemodialyzed patients present a severe problem when dialyzed against acetate and should be dialyzed against bicarbonate; 3) that dialysis against acetate does not fully correct the metabolic acidosis even in ‘normal’ patients.


Related Articles

  • Metabolic consequences of high mass-transfer hemodialysis. Tolchin, Nathan; Roberts, Jimmy L.; Hayashi, James; Lewis, Edmund J. // Kidney International;May1977, Vol. 11 Issue 5, p366 

    The metabolic fate of acetate (Ac) infused during hemodialysis and the acid-base changes attendant to its conversion to bicarbonate were studied in 20 patients. Twenty-eight studies were performed under three conditions! group 1, 40 mmoles/liter of Ac dialysate; group 2, 30 mmoles/liter of Ac...

  • Calcium and phosphate balance in adolescents on home nocturnal haemodialysis. Hothi, Daljit K.; Harvey, Elizabeth; Piva, Elizabeth; Keating, Laura; Secker, Donna; Geary, Denis F. // Pediatric Nephrology;Jun2006, Vol. 21 Issue 6, p835 

    Studies in adults show superior serum phosphate and parathyroid hormone (PTH) control on slow nocturnal haemodialysis (NHD) compared with conventional haemodialysis. We studied the progress of four children aged 12, 13, 14 and 16 years after they had been initiated on NHD. The follow-up period...

  • Abstracts.  // Kidney International;Nov1996, Vol. 50 Issue 5, p1773 

    Presents abstracts of articles on nephrology presented to the Société de Néphrologie in Caen, France. "A New Scintigraphic Method in Cases of Persistence or Recurrence of Secondary or Tertiary Hyperparathyroidism," by C. Billotey, E. Sarfati, J. D. Rain, and Y. Najean; "Benefits of...

  • Comparison of growth in primary Fanconi syndrome and proximal renal tubular acidosis. Shu-Yeh Hsu; I-Jung Tsai; Yong-Kwei Tsau // Pediatric Nephrology;Apr2005, Vol. 20 Issue 4, p460 

    To compare the difference between primary proximal renal tubular acidosis (PRTA) and Fanconi syndrome (FS), and to find out possible risk factors for growth retardation, we studied the long-term growth, clinical, laboratory, and radiological findings associated with the treatment of six children...

  • The Usefulness of Holotranscobalamin in Predicting Vitamin B12 Status in Different Clinical Settings. Herrmann, Wolfgang; Obeid, Rima; Schorr, Heike; Geisel, Jurgen // Current Drug Metabolism;Feb2005, Vol. 6 Issue 1, p47 

    Serum concentrations of homocysteine (Hcy) and methylmalonic acid (MMA) become increased in B12- deficient subjects and are therefore, considered specific markers of B12 deficiency. Serum level of holotranscobalamin (holoTC) becomes decreased before the development of the metabolic dysfunction....

  • Plasma Concentration of Galanin in Chronic Hemodialysis Patients. Legakis, Ioannis; Dardioti, Vasilliki; Moutafis, Spyros // Open Urology & Nephrology Journal;2012, Vol. 5, p1 

    Galanin has diverse physiological functions, including nociception, arousal/sleep regulation, congnition, and many aspects of neuroendocrine activities that are associated with feeding, energy metabolism, thermoregulation, osmotic and water balance, and reproduction. In an attempt to clarify the...

  • DIALYSIS - TRANSPLANTATION Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study). Qunibi, Wajeh Y.; Hootkins, Robert E.; McDowell, Laveta L.; Meyer, Micah S.; Simon, Matthias; Garza, Rodolfo O.; Pelham, Russell W.; Cleveland, Mark V. B.; Muenz, Larry R.; He, David Y.; Nolan, Charles R. // Kidney International;May2004, Vol. 65 Issue 5, p1914 

    Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study). Background. Hyperphosphatemia underlies development of hyperparathyroidism, osteodystrophy, extraosseous calcification, and is associated with increased mortality in hemodialysis...

  • Intraerythrocytic pH variations during hemodialysis: A ³1;P NMR study. Monti, J. P.; Gallice, P.; Baz, M.; Murisasco, A.; Crevat, A.; Elsen, R. // Kidney International;Mar1989, Vol. 35 Issue 3, p871 

    Before hemodialysis, patients have an intraerythrocytic pH (pHi) and an extracellular pH, measured in whole blood (pHo), which are lower than those of healthy controls. During bicarbonate hemodialysis, pHi values continuously increase, approaching a normal value at the end of the session....

  • COMPARISON OF ACETATE AND BICARBONATE BASED HEMODIALYSIS SOLUTIONS IN CORRECTION OF METABOLIC ACIDOSIS OF RENAL FAILURE. Reddy K., Sharath Kumar; Lakhmi, Dhana; Latha, Swarna; Kiranmayee; Sahay, Manisha; Narayen, Girish // Indian Journal of Nephrology;Jul-Sep2007, Vol. 17 Issue 3, p127 

    Aim: To compare efficacy of correction of metabolic acidosis on hemodialysis using bicarbonate V/s acetate buffer Materials and Methods: This prospective study was conducted at Dept of nephrology in the year 2007 in which 50 patients with renal failure (ARF or CRF) were included in this study....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics