長期血液透析における酸塩基平衡の経時的変動について 第2編: 血液透析療法における透析液中アセテート量の変化と酸塩基平衡について

Abstract

Acid-base balance was studied before, during and after hemodialysis on four patients of terminal renal failure who are on the maintenance hemodialysis with the Kiil type artificial kidney twice and 16 hours per week. Hemodialysis was carried out using dialysate containing acetate of various concentration. 1) Blood pH: With increase of acetate in dialysate, alkalemia was noted at the end of hemodialysis. When dialysate containing 37 or 39 mEq/L of acetate was used, predialytic alkalemia was present and was more enhanced at the end of dialysis. When dialysate containing 33 or 35 mEq/L of acetate was used, predialytic value was almost normal. 2) PCO2: Predialytic and postdialytic PCO2 were well balanced regardless acetate content. Predialytic PCO2 rose according to the increase of acetate content and reached the nearly normal range. 3) Actual bicarbonate: At the end of hemodialysis, acidosis was well improved regardless the acetate content. It was 23.8±2.4 mEq/L when dialysate with 35 mEq/L of acetate was used, and hyperbasemia was noted when dialysate with 37 or 39 mEq/L of acetate was used. On the other hand hypobasemia was noted to such an extent as 23.1±1.2 mEq/L of PCO2 when dialysate with 33 mEq/L of acetate was used. 4) Base excess: Predialytic hypobasemia was noted when dialysate containing 33 mEq/L of acetate. When other dialysates were used, predialytic value was within normal range. At the end of hemodialysis, hyperbasemia appeared when dialysate containing 37 or 39 mEq/L of acetate was used, but it was normal when 33 or 35 mEq/L of acetate was used. 5) From the above results, acid-base balance should be best maintained if dialysate containing acetate of 35 mEq/L was used for 16 hours dialysis per week.