The International journal of artificial organs
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The type of metabolic acidosis in patients with chronic renal failure was studied prospectively over a three-month period in 32 stable patients on chronic hemodialysis using acetate. All patients had pre-dialysis metabolic acidosis (mean TCO2 = 16.6 +/- 0.4 mEq/l, range 10 to 23 mEq/l). The patterns of metabolic acidosis were defined using the ratio: delta AG/delta TCO2 where delta AG is the increment in plasma anion gap above normal and delta TCO2 the decrement in plasma bicarbonate below normal. ⋯ An inverse correlation between the TCO2 change (y) during the dialysis procedure and the TCO2 (x) prevailing at the start of dialysis was found by linear regression analysis: y = -0.51x + 11, r = -0.54, p less than 0.01. Thus, before acetate conversion to bicarbonate was fully completed, patients gained bicarbonate during dialysis if TCO2 was less than 21 mEq/l and lost it when the pre-dialysis TCO2 was above this level. On average, the delta AG was reduced to a greater extent than the delta TCO2 so that the delta AG/delta TCO2 ratio fell significantly (from 53 +/- 7.1 to 11 +/- 8.8%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Hemodynamic tolerance and plasma volume variations during plasma exchange. Replacement fluid: albumin alone or albumin plus gelatin?
Little is known about mechanisms of systemic hypotension frequently reported during plasma exchange (PE). Type of substitution fluids may interfere with hemodynamic tolerance. In a prospective study, right heart catheterization was performed during 18 PE by filtration with isovolumic substitution. ⋯ Plasma volume also decreases after PE: group A: - 13.5 +/- 4%; group A + G: - 18.5 +/- 4%. None of the variations are significantly different between the two groups. So we think that substitution with albumin alone has no advantage for hemodynamic tolerance.