Acetate-free Biofiltration for the Prevention of Intradialytic Hypеrcapnia in a Patient with Limited Pulmonary Reserve

Laura Di Leo, Maria Luisa Querques, Chiara Brunati, Mara Cabibbe, Alberto Menegotto, Alberto Montoli, Giacomo Colussi


A case of acute hypercapnia occurring during a session of bicarbonate hemodialysis is reported. The 82-year old female patient was affected by cardiac insufficiency, pulmonary hypertension and chronic obstructive lung disease. She developed acute symptomatic respiratory acidosis immediately after the beginning of a bicarbonate hemodialysis session, with arterial pH of 7.25 and paCO2 of 48.1 mmHg. This was related to the well known, but frequently forgotten, CO2 load from bicarbonate-based dialysate.
We treated her with acetate-free biofiltration, with stable paCO2 throughout the session. Physiopathology of blood gas dynamics during hemodialysis is reviewed.


respiratory acidosis; hypercapnia; bicarbonate hemodialysis; acetate-free biofiltration

Full Text:



Ryzlewicz T. The wrong prescription of dialysis fluid // J. Nephrol. Ther. 2015; 5: e113 doi: 10.4172/2161-0959.1000e113

Golper T.A., Fissel R., Fissel W.H., Hartle M., Sanders M.L., Schulman G. Hemodialysis: core curriculum 2014 // Am. J. Kidney Dis. 2014; 63: 153-63.

Symreng T., Flanigan M.J., Lim V.S. Ventilatory and metabolic changes during high efficiency hemodialysis // Kidney Int. 1992; 41: 1064-1069.

Feriani M. Behaviour of acid-base control with different dialysis schedules // Nephrol. Dial. Transplant. 1998; 13 (S6): s62-s65.

Ledebo I. Acid base correction and convective dialysis therapies // Nephrol. Dial. Transplant 2000; 15: 45-48.

Marano M. Alterazioni gasanalitiche in bicarbonato dialisi // G. Ital. Nefrol. 2013; 30: 1-8.

Alfakir M., Moammar M. Pulmonary gas exchange during hemodialysis: a comparison of subjects with and without COPD on bicarbonate hemodialysis // Ann. Clin. Lab. Science 2011; 41: 315-320.

Kao C.C., Guntupalli K.K., Bandi V., Jahoor F. Whole-body CO2 production as an index of the metabolic response to sepsis // Shock 2009; 32: 23-28.

Hyz R.C., Hidalgo J. Permissive hypercapnia. UpToDate. Waltham, MA, 2015.

Patriarca A., Marano M. Insolita indicazione per l’ AFB: il paziente ipercapnico. Abst 54°congress Italian Society of Nephrologya // G. Ital. Nefrol. 2013; 30 (S61): s88.

Marano M., Patriarca A., Zamboli P. Acidosi respiratoria: colpa della fistola arterovenosa. Abst. 54th congress Italian Society of Nephrology // G. Ital. Nefrol. 2013; 30(S61): s88.

Sigdell J.E, Tersteegen B. Clearance of a dialyzer under varying operating conditions // Artif. Organs. 1986; 10: 219-225

Pitcher W.D., Diamond S. Pulmonary gas exchange during dialysis in patients with obstructive lung disease // Chest. 1989; 96: 1136-1141

Martello M., Di Luca M. Acetate Free Biofiltration // G. Ital. Nefrol. 2012; 29 (S55): s62-s71

Marano M., D’Amato A., Patriarca A., Di Nuzzi L.M., Giordano G., Iulianiello G. Carbon dioxide and acetate free biofiltration: a relationship to be investigated // Artif. Organs. 2015; doi: 10.1111/aor.12477

Roscoe J.M., Goldstein M.B., Halperin M.L., Wilson D.R., Sinebaugh B.J. Lithium-induced impairment of urine acidification // Kidney Int. 1976; 7: 344-350.

Copyright (c) 2016 KIDNEYS

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© "Publishing House "Zaslavsky", 1997-2019


   Seo анализ сайта