The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial: a phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation

BMC Nephrology

Research Article

Margarita Askelson¹  James Zhao¹  Brigid Flanagan²  Len A. Usvyat³  John W. Larkin³  Franklin W. Maddux³  Kendra S. Hendon⁴  George E. Newman⁴  Ravi I. Thadhani⁵  Jamil Hantash⁶  William B. Smith⁷  Sandy Gibson⁷ 

[1] EDETEK, 500 College Road East, Suite 200, 08540, Princeton, NJ, USA;Frenova Renal Research, 920 Winter Street, 02451, Waltham, MA, USA;Fresenius Medical Care North America, 920 Winter Street, 02451, Waltham, MA, USA;Knoxville Kidney Center, PLLC, 320 Park 40 N Blvd, 37923, Knoxville, TN, USA;Massachusetts General Hospital Division of Nephrology, 55 Fruit Street #1008, 02114, Boston, MA, USA;Tandem Labs, 115 Silvia Street, 08628, West Trenton, NJ, USA;Volunteer Research Group and New Orleans Center for Clinical Research at the University of Tennessee Medical Center, 1928 Alcoa Highway, Suite 107, 37920, Knoxville, TN, USA;

关键词: Hemodialysis;    Dialysate;    Bicarbonate;    Acetate;    Acid-Base;    Hemodynamics;    Metabolism;   

DOI  :  10.1186/s12882-017-0683-6

 received in 2016-11-21, accepted in 2017-08-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients.MethodsThe Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte® and GranuFlo® acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD.ResultsData from 20 HD treatments for 11 patients (10 NaturaLyte® and 10 GranuFlo®) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte® and GranuFlo® (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo® and 28.8 (SD ± 4.26) mEq/L in NaturaLyte®. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events.ConclusionsA small fraction of acetate was delivered to HD patients with use of NaturaLyte® and GranuFlo® acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate.Trial registrationThis trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267).

【 授权许可】

CC BY   
© The Author(s). 2017

【 图 表 】

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Fig. 1