The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure

• Published in: Intensive care medicine 1999-11, Vol.25 (11), p.1244-1251
• Main Authors: HEERING, P, IVENS, K, THÜMER, O, MORGERA, S, HEINTZEN, M, PASSLICK-DEETJEN, J, WILLERS, R, STRAUER, B. E, GRABENSEE, B
• Format: Article
• Language: English
• Subjects: Acid-Base Equilibrium; Acidosis; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Bicarbonates - blood; Biological and medical sciences; Blood pressure; Buffers; Cohort Studies; Creatinine - blood; Electrolytes - blood; Emergency and intensive care: renal failure. Dialysis management; Female; Fluids; Hemodynamics; Hemofiltration; Humans; Hydrogen-Ion Concentration; Illnesses; Intensive care; Intensive care medicine; Lactates - blood; Male; Medical sciences; Middle Aged; Mortality; Patients; Prospective Studies; Sodium Acetate - therapeutic use; Sodium Bicarbonate - blood; Sodium Bicarbonate - therapeutic use; Sodium Lactate - blood; Sodium Lactate - therapeutic use
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340051052

To determine the impact of different hemofiltration (HF) replacement fluids on the acid-base status and cardiovascular hemodynamics in patients with acute renal failure (ARF) and continuous veno-venous hemofiltration (CVVH). Prospective, cohort study. Intensive Care Unit of the Heinrich Heine University Hospital, Düsseldorf, Germany. One hundred and thirty-two critically ill patients with acute renal failure and continuous veno-venous HF were studied. Fifty-two patients were subjected to lactate-based (group 1), and 32 to acetate-based hemofiltration (group 2) while 48 (group 3) were treated with bicarbonate-based buffer hemofiltration fluid. Fifty-seven had a septic, and 75 a cardiovascular, origin of the ARF. Creatinine, blood urea nitrogen (BUN), serum bicarbonate, arterial pH, lactate and Apache II scores were noted daily. The mean CVVH duration was 9.8 +/- 8.1 days, mortality was 65%. No difference was present between the groups under investigation with regard to the main clinical parameters. Lactate- and bicarbonate-based hemofiltration led to significantly higher serum bicarbonate and arterial pH values as compared to the acetate-based hemofiltration. Serum bicarbonate values at 48 h after the initiation of CVVH treatment were 25.7 +/- 3.8 mmol/l (p < 0.001) in group 1, 20.6 +/- 3.1 mmol/l in group 2 and 23.3 +/- 3.9 mmol/l (p < 0.001) in group 3. While a lack of increase in serum bicarbonate and arterial pH was correlated to poor prognosis in lactate- and bicarbonate-based hemofiltration, no such observation was made in acetate-based hemofiltration. Cardiovascular hemodynamics were superior in patients treated with lactate- and bicarbonate-based buffer solution as compared to those treated with acetate-based buffer solution. The degree of correction of acidosis during hemofiltration was determined by patient outcome in patients treated with lactate- and bicarbonate-based buffer solutions, but not in patients receiving acetate-buffered solution. Bicarbonate and lactate-based buffer solutions were found to be superior to acetate-based replacement fluid.