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Nephrol Dial Transplant (1993) 8: 54-59
© 1993 European Renal Association-European Dialysis and Transplant Association

research-article

New reinfusate composition in high UF haemodiafiltration: electrolyte solution combined with bicarbonate

M. Gonella, G. Calabrese, G. Pratesi, C. Baldin, A. Mazzotta and G. Vagelli

Servizio di Nefrologia e Dialisi, Laboratorio di Analisi, Ente Ospedaliero Casale Monferrato, Italia

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr M. Gonella, Servizio di Nefrologia e Dialisi, Ente Ospedaliero. 15033 Casale Monferrato, Italia

When high-permeability membranes are employed, high UF should be used in order to obtain optimal uraemic toxin removal and to avoid backfiltration. A high UF requires the infusion of an electrolyte solution including Ca2+ and Mg2+ which cannot be associated with bicarbonate in prepackaged solutions because of the risk of precipitation; therefore acetate or lactate are used as buffers.

This study evaluated whether bicarbonate can be infused together with an electrolyte solution in high UF HDF, and if so, the clinical advantages that could be obtained by substituting acetate with bicarbonate in the reinfusate.

In 12 patients on postdilutional high UF (121±10 ml/min) HDF (Qb 400, Qd 500 ml/min, dialysate containing Na, 141 ±2; K, 2.5; Ca, 3.5; Mg, 0.7; Cl, 111±2; acetate, 3; bicarbonate, 34 mEq/1; TMP 400 mmHg), an acid bag (Na, 128; K, 4; Ca, 7; Mg, 2; Cl, 141; acetate, 8 mEq/1), and a basic bag (Na, 150; HCO3, 80; Cl, 70 mEq/1), each containing 2 litres, were simultaneously infused through a Y connection.

The final composition of reinfusate at the drip-chamber, combined with the above dialysate, allowed a negative intradialytic mass balance for Na, K, Mg and a positive one for Ca, acetate, to maintain pre-postdialytic plasma values of these ions as well as bicarbonate close to normal limits.

Furthermore, in five high-risk patients, clinical data were evaluated on high UF HDF, infusing a solution containing either acetate or bicarbonate, and an improvement of vascular stability was observed with the bicarbonate reinfusate.

Therefore, in high UF HDF, bicarbonate can be infused along with an electrolyte solution, avoiding unphysiological levels of other buffers, and improving vascular stability in high-risk patients.

Keywords: High UF HDF; electrolyte and bicarbonate reinfusion; electrolyte mass balance; acid-base balance; vascular stability


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