Giuseppe Mioni

Acid-base metabolism in short dialysis

Clinical application of short dialysis has become feasible since the introduction of the high efficiency type of dialyzer, which has enabled high rates of water and solute exchange between the blood and the dialysate to be obtained [1, 2]. The side effects of this aggressive dialysis technique, such as symptomatic hypotension, muscolar cramps, plasma bicarbonate dissipation, etc., were the price that had to be paid for a more rapid and intensive metabolic waste product elimination [1–5]. Besides the problem of dialysate sodium concentration, which was progressively increased from 132–135 to 140 mmol/1 or more [2, 3, 6, 7], the following problems had to be faced: the high performance of the dialyzers; the kind of buffers in the dialysis bath; the choice of the single-pass (SP) or the recirculating dialysate delivery system (RS); the rate of body weight loss, i.e., water ultrafiltration rate (Qf). The solution of these new problems appeared strictly connected with the dialysis correction of A-B status.