HAEMO-DIALYSIS -FILTRATION USING SODIUM-BICARBONATE DEPRESSES CARDIAC-FUNCTION IN CRITICALLY ILL PATIENTS WITH ACUTE-RENAL-FAILURE/

The effect of sodium bicarbonate haemodialysis or haemofiltration on c ardiac function was prospectively studied in 8 patients with acute ren al failure. All of the patients exhibited consciousness disturbance an d seven patients were on mechanical ventilation. All but one of the pa tients demonstrated moderate hyperlactataemia and seven patients were receiving vasoactive amine support. Arterial and mixed venous gas anal ysis and haemodynamic measurements were performed before and after hae modialysis/-filtration treatment. The buffer was changed in a randomis ed order between bicarbonate and acetate and 11 crossover studies were completed. After treatment with bicarbonate, the cardiac index and st roke index decreased significantly (4.0+/-0.3 to 3.4+/-0.4 L/ min/m(2) ; p<0.05 and 39.6+/-2.5 to 32.9+/-1.8L/m(2) p<0.05), whereas no signif icant changes were observed in cardiac index or stroke index after tre atment with acetate. Therefore, the post-dialytic percent changes of c ardiac index, stroke index and left ventricular stroke work index were significantly decreased after bicarbonate sessions, as compared to af ter acetate sessions. Haemo-dialysis/ -filtration using sodium bicarbo nate can depress cardiac function in critically ill patients on mechan ical ventilation with disturbed consciousness, and in those who are re ceiving vasoactive amine support due to uncompromised haemodynamics as sociated with hyperlactataemia.