EFFECTS OF ACETATE ON LEFT-VENTRICULAR FUNCTION IN HEMODIALYSIS-PATIENTS

Two approaches were chosen to assess the controversially debated influ ence of acetate on the heart in dialysis patients: (1) To separate ace tate effects from influences of dialysis, acetate was infused in 12 ch ronic dialysis patients with normal systolic function on a dialysis-fr ee day, and left ventricular (LV) function was assessed by LV pressure /volume loops. Hyperacetatemia (3-5 mmol/l) resulted in a decrease in LV preload (LV end-diastolic pressure decreased from 16 +/- 3 to 10 +/ - 4 mm Hg, p < 0.01) but had no influence on LV contractility. (2) In 8 dialysis patients without cardiac disease, isovolemic acetate or bic arbonate dialysis was performed. During both procedures, there were co mparable changes in serum electrolytes as well as in echocardiographic parameters. LV contractility measured by velocity of circumferential fiber shortening increased during acetate and bicarbonate dialysis (1. 47 +/- 0.22 to 1.77 +/- 0.29, p < 0.01; 1.47 +/- 0.21 to 1.70 +/- 0.22 circ/s, p < 0.01. It is concluded that mild hyperacetatemia does not influence LV contractility and that dialysis-induced changes in serum electrolytes are responsible for the increase in LV contractility duri ng dialysis. However, the pronounced acetate effect on LV preload impl ies considerable therapeutic implications.