Dialysate Buffer in Hemodialysis

Acid concentrate

Acid concentrate

water, combined with removal of water by ultrafiltration, leads to contraction of the intravascular space and contributes to the development of hypotension. High-sodium dialysate helps to minimize the development of hypo-osmolality. As a result, fluid can be mobilized from the intracellular and interstitial compartments to refill the intravascular space during volume removal. Other potential mechanisms whereby low-sodium dialysate contributes to hypotension are indicated. Na—sodium; BUN—blood urea nitrogen; PGE2—prostaglandin E2. FIGURE 2-2

There has been interest in varying the concentration of sodium (Na) in the dialysate during the dialysis procedure so as to minimize the potential complications of a high-sodium solution and yet retain the beneficial hemodynamic effects. A high sodium concentration dialysate is used initially and progressively the concentration is reduced toward isotonic or even hypo-

Directly decreases peripheral vascular resistance in approximately 10% of patients Stimulates release of the vasodilator compound interleukin 1 Induces metabolic acidosis via bicarbonate loss through the dialyzer Produces arterial hypoxemia and increased oxygen consumption ?Decreased myocardial contractility

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