Ａｃｅｔａｔｅ　ｆｒｅｅ　ｂｉｏｆｉｌｔｒａｔｉｏｎの高Ｎａ効果についての検討

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  • The effect of high sodium in acetate free biofiltration
  • Acetate free biofiltration ノ コウNa コウカ ニ ツイテ ノ ケントウ

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It was previously reported that the effect of acetate free biofiltration (AFBF) in retaining blood pressure is attributable to the sodium-replenishing effect of the sodium bicarbonate solution used for AFBF.<br>In the present study, we performed hemodialysis (HD), high sodium dialysis, hemodiafiltration (HDF) and AFBF in 10 stable patients receiving maintenance hemodialysis. The systolic blood pressure (SBP), plasma sodium level, plasma osmotic pressure, the sodium level in the dialysate and the amount of sodium eliminated (pooled completely) were measured and analyzed to evaluate the sodium-replenishing effect and usefulness of AFBF. The following results were obtained.<br>The SBP measured 4 hours after the start of AFBF was significantly higher than that measured 4 hours after HD. Blood pressure was highest during AFBF compared to that during an other procedures, thus indicating the effect of AFBF in maintaining blood pressure.<br>Plasma sodium level rose over time after the start of AFBF, recording 144 mEq/L at 4 hours which was significantly higher than the level recorded 4 hours after the start of HDF or HD. In analysis of sodium input and output, the amount of sodium in vivo was greater following AFBF than following any other procedure. This may represent the outcome of serial infusion of sodium carbohydrate solution (166 mEq/L) at a rate of 1.5L/h. This finding may be the reason why it was previously reported that the blood-retaining effect of AFBF is attributable to its sodium-replenishing effect.<br>However, the amount of sodium eliminated following AFBF was comparable to that following high sodium dialysis and was significantly higher than that following HD or HDF. This suggests that during AFBF, sodium is eliminated by ultrafiltration (1.5L/h) and dispersion of Bifil-S which flows towards the side of dialysate with a relatively low concentration (139 mEq/L). In analysis of plasma osmotic pressure, which is an important indicator of the sodium-replenishing effect, plasma osmotic pressure did not rise but tended to decrease over time, unlike its time course after high sodium dialysis.<br>These results suggest that blood pressure retention observed following AFBF is not attributable to the socalled pure sodium-replenishing effect but can be explained by a combination of the sodium-replenishing effect, effects of HDF and suppression of peripheral vessel dilation by the acetate-free procedure, and that the lack of an increase in acetate by AFBF is clinically beneficial.

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