ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Adding a dialysis filter to the perfusion circuit at the end of cardiopulmonary bypass (CPB) has become an accepted means of reducing potassium rapidly and safely. Rapid removal of solute requires a dialysate for diffusion, and peritoneal dialysis solutions have been the standard because of availability, although occasionally normal saline or bicarb/ saline mixtures are used. Cardioplegia solution is high in glucose as well as potassium and, with many diabetic patients undergoing CPB, it is desirable to minimize glucose loads. ⋯ The lactate dialysate (LD) group received a mean of 17.4+/-7.7 L of lactate containing dialysate versus 14.6+/-4.7 L of bicarbonate dialysate (BD) (p = 0.41). After dialysis, potassium had been reduced to a similar degree in both groups, but plasma glucose levels had increased during LD while they fell during BD, and bicarbonate levels fell during LD while they rose during BD. Use of a commercially available sterile bicarbonate dialysate can safely help to lower plasma potassium during CPB and preserve more physiologic levels of glucose and bicarbonate.
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Satisfactory hemodialysis access flow (Qa) is necessary for dialysis adequacy. However, high access flows are postulated to increase cardiac output (CO). The relationship between Qa and CO is not well defined. ⋯ With BVdelta, the Qa is maintained while the CO falls and the Qa/CO increases, perhaps by reflex vasoconstriction of the systemic circulation. Longitudinal studies are required to determine which is the dependent variable. A low Qa/CO may indicate access dysfunction.
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Editorial Comparative Study
Good news, bad news for diabetic versus nondiabetic end-stage renal disease: incidence and mortality.