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Background. The discussion about the pathogenesis of renal anaemia, whether it is primarily due to relative erythropoietin (Epo) deficiency or to uraemic inhibition of erythropoiesis, is still open. Although it has so far not been possible to identify or isolate a substance retained in uraemia with a suppressive action directed specifically against red‐cell production, dialysis therapy can improve the effect of both residual endogenous Epo and exogenous rHuEpo. To what extent the mode and/or the dose of dialysis influence Epo efficacy is as yet poorly understood. [ABSTRACT FROM PUBLISHER]

In a prospective, randomised, double blind controlled trial the adverse reactions, food consumption, changes in blood chemistry including acid–base balance, and anthropometry were studied during two consecutive dialysis periods of 3 months, using either acetate- or bicarbonate-based dialysis fluids. Sixteen chronic, stable patients were included. The dialysis fluid sodium content was fixed at 140 mmol/l during all treatments.Patient complaints and adverse reactions were identical using the two dialysis fluids. No differences were observed regarding blood chemistry except for a less pronounced metabolic acidosis present during bicarbonate dialysis compared to acetate dialysis. A slight but insignificant increment in food consumption and nutritional status was noticed during bicarbonate dialysis.In conclusion, the use of a bicarbonate-based haemodialysis fluid offered no significant advantages compared to an acetate-based one in the haemodialysis of chronic, stable patients. [ABSTRACT FROM PUBLISHER]

To evaluate the role of bicarbonate loss through the dialyser and acetate flux to the patient in the development of symptoms during acetate dialysis, bicarbonate loss during acetate dialysis was prevented by using a combination of acetate and bicarbonate in the dialysate. Seven uraemic patients were treated for 4 months with acetate dialysis and, successively, for a similar period of time with bicarbonate, and a combination of acetate and bicarbonate dialysis. Blood-pressure drop and the incidence of hypotension and symptomatic episodes were similar in bicarbonate and combination dialysis, and significantly lower than in acetate dialysis. Serum acetate concentrations were similar during acetate and combination dialysis. These findings indicate that bicarbonate loss rather than the presence of acetate was responsible for the patients' intolerance to acetate dialysis. [ABSTRACT FROM PUBLISHER]

The effect of left ventricular function on changes in plasma volume during acetate and bicarbonate dialysis was studied in stable, chronic dialysis patients. Preservation of plasma volume in patients with a normal left ventricular function (mean circumferential fibre shortening velocity (VcF) ≥ 1 circ/s) was significantly less during the first hour of acetate dialysis than during bicarbonate dialysis. However, in patients with impaired left ventricular function (VcF < 1 circ/s) the decrease in plasma volume was more pronounced during acetate when compared to bicarbonate dialysis. This resulted in a decreased ultrafiltration volume and haemodynamic instability in these patients during acetate dialysis. The fibre shortening velocity increased during acetate and bicarbonate dialysis in patients with a normal left ventricular function, whereas in patients with impaired left ventricular function fibre shortening velocity increased only during bicarbonate dialysis. In conclusion, in patients with an impaired left ventricular function, bicarbonate is preferable to acetate in chronic dialysis. [ABSTRACT FROM PUBLISHER]