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1編: 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

Abstract

Acid-base balance was studied before, during and after hemodialysis on four patients on the maintenance hemodialysis with the Kiil type artificial kidney. The patients were divided into two groups, Group I (one 8 hours dialysis per week) and Group II (two 8 hours dialysis per week), according to their 24 hour urinary volume. 1) Blood pH: Both Group I and II showed some alkalemia at the end of hemodialysis, Group II being more remarkable than Group I. Comparison of blood pH of the inflow and outflow side did not show difference. After hemodialysis pH gradually decreased but remained within normal range even 12 to 48 hours. 2) PCO2: During hemodialysis it showed very little change. After hemodialysis, it gradually increased and reached the highest value in 6 hours followed by gradual decrease. Hypocapnia was striking on the outflow side compared with the inflow side. 3) Actual bicarbonate returned to the normal value at the end of hemodialysis, but somewhat slowly in Group II. Hypobasemia was remarkable on the outflow side. 4) Base excess was corrected at the end of hemodialysis both Group I and II. After dialysis, it gradually decreased just as actual bicarbonate did. Hypobasemia was still striking on the outflow side. 5) Hemodialysis using dialysate containing 33 mEq/L of acetate did not result in the sufficient improvement of acid-base balance in some cases. This fact suggests composition of dialysate has to be changed by case for the better acid-base balance.