nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2011-15-4-34-38nefr-657Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSДИНАМИКА АЦЕТАТЕМИИ ПРИ ПРИМЕНЕНИИ БИКАРБОНАТНОГО И БЕЗАЦЕТАТНОГО ДИАЛИЗАТА У БОЛЬНЫХ С ОСТРЫМ ПОЧЕЧНЫМ ПОВРЕЖДЕНИЕМTHE DYNAMICS OF ACETATEMIA WITH USING BICARBONATE AND ACETATE-FREE DIALYSATE IN PATIENTS WITH ACUTE KIDNEY INJURYУНАРОКОВЗ. М.UNAROKOVZ. M.

Отделение гемодиализа и экстракорпоральной детоксикации

МУХОЕДОВАТ. В.MUKHOEDOVAT. V.

Отделение гемодиализа и экстракорпоральной детоксикации

ШУВАЕВАО. В.SHUVAEVAO. V.

аналитическая лаборатория

Новосибирскикий научно-исследовательский институт патологии кровообращения им. акад. Е.Н. МешалкинаRussian FederationИнститут неорганической химии им. А.В.Николаева Сибирского отделения РАНRussian Federation2011100420111543438Copyright © УНАРОКОВ З.М., МУХОЕДОВА Т.В., ШУВАЕВА О.В., 20112011УНАРОКОВ З.М., МУХОЕДОВА Т.В., ШУВАЕВА О.В.UNAROKOV Z.M., MUKHOEDOVA T.V., SHUVAEVA O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/657ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить сравнительное влияние SLEDD (sustained low-efficiency daily dialysis) со стандартным бикарбонатным и полностью безацетатным диализатом на динамику ацетатемии и гемодинамическую стабильность у больных с острым почечным повреждением (ОПП) после кардиохирургических операций. ПАЦИЕНТЫ И МЕТОДЫ. Тридцать пять больных с ОПП, нуждавшихся в проведении заместительной почечной терапии (ЗПТ), были рандомизированы в 2 группы. В группе А (n=18) проведено 46 SLEDD с бикарбонатным диализатом (содержание ацетата 3 ммоль/л). В группе В проведено 52 SLEDD с полностью безацетатным диализатом «Кребсол». Оценивались уровень ацетата в сыворотке крови, показатели кислотно-основного состояния (КОС) и электролиты, эпизоды интрадиализных гипотензий и аритмий. РЕЗУЛЬТАТЫ. Исходная концентрация ацетата сыворотки крови повысилась в среднем в 4 раза после SLEDD с бикарбонатным диализатом. Напротив, уровень ацетата не изменился после SLEDD с безацетатным диализатом. В обеих группах достигнуто снижение азотемии и стабильная коррекция кислотно-основного и электролитного гомеостаза. В то же время, применение безацетатного диализата статистически значимо снижало частоту гемодинамических осложнений. ЗАКЛЮЧЕНИЕ. По нашим данным, даже «небольшие» концентрации ацетата в стандартном бикарбонатном диализирующем растворе могут являться причиной значительной ацетатемии и, как следствие, индуцировать гемодинамические осложнения во время SLEDD у больных с ОПП. Применение полностью безацетатного диализирующего раствора уменьшает риск развития интрадиализных осложнений.

THE AIM of this study was to examine relative effect of SLEDD (sustained low-efficiency daily dialysis) with standard bicarbonate and with acetate-free dialysate on acetatemia dynamics and haemodynamic stability in patients with acute kidney injury (AKI) after cardiac surgery. PATIENTS AND METHODS. Thirty-five patients with AKI., who requires renal replacement therapy (RRT), were divided into two 2 groups. 46 SLEDD with bicarbonate dialysate (contains 3 mmol/l of acetate) were performed in group A (n=18). 52 SLEDD with acetate-free dialysate «Krebsol» were performed in group B. Serum acetate level, acid-base balance factors and electrolytes, episodes of intradialisis hypotension and arrhythmias were evaluated. RESULTS. After SLEDD with bicarbonate dialysate initial acetate concentration increased averagely 4 times. On the contrary, after SLEDD with acetate-free dialisate acetate range didn't alter. In both groups was achieved decrease of azotaemia and permanent correrction of electrolytic homeostasis and acid-base balance. At the same time usage of acetate-free dialysate significantly modulated hemodynamic complications. CONCLUSION. The study has shown that even «small» acetate concentrate in standard bicarbonate dialysate may become a cause of significant acetatemia and, as a consequence, can induce hemodynamic complications at SLEDD in patients with AKI. Usage of SLEDD with acetate-free dialysate reduced risk of intradialisis complications development

острое почечное повреждениеSLEDDацетатбезацетатный диализacute kidney injurySLEDDacetateacetate-free dialysisReferencesKumar V.A., Craig M., Depner T., Yeun J.Y. Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J. Kidney Dis 2000; 36: 294 -300Kumar V.A., Craig M., Depner T., Yeun J.Y. Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J. Kidney Dis 2000; 36: 294 -300Tonelli M., Manns B., Feller-Kopman D. Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J. Kidney Dis 2002; 40: 875-885Tonelli M., Manns B., Feller-Kopman D. Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J. Kidney Dis 2002; 40: 875-885Marshall M.R., Ma T., Galler D. et al. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant 2004; V. 19: 877-884Marshall M.R., Ma T., Galler D. et al. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant 2004; V. 19: 877-884Lonnemann G., Floege J., Kliem V. et al. Extended daily veno-venous high flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system. Nephrol Dial Transplant 2000; 15: 1189-1193Lonnemann G., Floege J., Kliem V. et al. Extended daily veno-venous high flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system. Nephrol Dial Transplant 2000; 15: 1189-1193Kielstein J.T., Kretschmer U., Ernst T. et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J. Kidney Dis 2004; 43(2): 342-349.Kielstein J.T., Kretschmer U., Ernst T. et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J. Kidney Dis 2004; 43(2): 342-349.Kumar V.A., Yeun J.Y., Depner T.A., Don B.R. Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure. Int J. Artif Organs 2004; 27(5): 371-379Kumar V.A., Yeun J.Y., Depner T.A., Don B.R. Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure. Int J. Artif Organs 2004; 27(5): 371-379Bellomo R., Baldwin I., Naka T. et al. Длительная интермиттирующая почечно-заместительная терапия в отделении реанимации. Анестезиология и реаниматология 2005; (2): 74-78Bellomo R., Baldwin I., Naka T. et al. Длительная интермиттирующая почечно-заместительная терапия в отделении реанимации. Анестезиология и реаниматология 2005; (2): 74-78Ricci Z., Ronco C. Dose and efficiency of renal replacement therapy: Continuous renal replacement therapy versus intermittent hemodialysis versus slow extended daily dialysis. Crit Care Med 2008; 36 (Suppl 4): S229-S237Ricci Z., Ronco C. Dose and efficiency of renal replacement therapy: Continuous renal replacement therapy versus intermittent hemodialysis versus slow extended daily dialysis. Crit Care Med 2008; 36 (Suppl 4): S229-S237Fournier G., Potier J., Thebaud H.-E. et al. Substitution of acetic acid for hydrcloric acid in the bicarbonate buffered dialysate. Intern Soc for Artifical Org 1998; 22(7): 608-613Fournier G., Potier J., Thebaud H.-E. et al. Substitution of acetic acid for hydrcloric acid in the bicarbonate buffered dialysate. Intern Soc for Artifical Org 1998; 22(7): 608-613Ding F., Ahrenholz P., Winkler R.E. et al. Online hemodiafiltration versus acetate-free biofiltration: a prospective crossover study. Artif Organs 2002; 26(2): 169-180Ding F., Ahrenholz P., Winkler R.E. et al. Online hemodiafiltration versus acetate-free biofiltration: a prospective crossover study. Artif Organs 2002; 26(2): 169-180Pizzarelli F., Cerrai T., Dattolo P. et al. On-line haemdiafiltration with and without acetate. Nephrol Dial Transplant 2006; 21(6): 1648-1651Pizzarelli F., Cerrai T., Dattolo P. et al. On-line haemdiafiltration with and without acetate. Nephrol Dial Transplant 2006; 21(6): 1648-1651Coll E., Perez-Garcia R., Martin de Francisco A.L. et al. Acetate-free on-line PHF: how to improve hyperacetatemia and haemodynamic tolerance. Nefrologia 2009; 29(2): 156-162Coll E., Perez-Garcia R., Martin de Francisco A.L. et al. Acetate-free on-line PHF: how to improve hyperacetatemia and haemodynamic tolerance. Nefrologia 2009; 29(2): 156-162Kirkendol P.L., Devia C.J., Bower J.D., Holbert R.D. A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions. Trans Am Soc Artif Intern Organs 1977; 23: 399-405Kirkendol P.L., Devia C.J., Bower J.D., Holbert R.D. A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions. Trans Am Soc Artif Intern Organs 1977; 23: 399-405Tolchin N., Roberts J.L., Hayashi J., Lewis E.J. Metabolic consequences of high mass-transfer hemodialysis. Kidney International 1977; 11: 366-378Tolchin N., Roberts J.L., Hayashi J., Lewis E.J. Metabolic consequences of high mass-transfer hemodialysis. Kidney International 1977; 11: 366-378Tollinger C.D., Vreman H.J., Weiner M.W. Measurement of acetate in human blood by gas chromatography: effect of sample preparation, feeding, and various diseases. Clin Chem 1979; 25/10: 1787-1790Tollinger C.D., Vreman H.J., Weiner M.W. Measurement of acetate in human blood by gas chromatography: effect of sample preparation, feeding, and various diseases. Clin Chem 1979; 25/10: 1787-1790Bolasco P., Ghezzi P. M., Serra A., et al. Effects of acetate-free haemodiafiltration (HDF) with endogenous reinfusion (HFR) on cardiac troponin levels. Nephrol Dial Transplant 2011; 26(1): 258-263Bolasco P., Ghezzi P. M., Serra A., et al. Effects of acetate-free haemodiafiltration (HDF) with endogenous reinfusion (HFR) on cardiac troponin levels. Nephrol Dial Transplant 2011; 26(1): 258-263Amore A., Cirina P., Mitola S. et al. Acetate intolerance is mediated by enhanced synthesis of nitric oxide by endothelial cells. J. Am Soc Nephrol 1997; 8: 1431-1436Amore A., Cirina P., Mitola S. et al. Acetate intolerance is mediated by enhanced synthesis of nitric oxide by endothelial cells. J. Am Soc Nephrol 1997; 8: 1431-1436Мухоедова Т.В., Унароков З.М. Опыт применения sustained low efficiency dialysis (sled) -технологий заместительной почечной терапии в лечении кардиоренального синдрома с диуретик-рефрактерными отеками. Нефрология 2010; 14 (1): 63-67Мухоедова Т.В., Унароков З.М. Опыт применения sustained low efficiency dialysis (sled) -технологий заместительной почечной терапии в лечении кардиоренального синдрома с диуретик-рефрактерными отеками. Нефрология 2010; 14 (1): 63-67Mukhoedova T., Unarokov Z. Sustained low-efficiency daily dialysis with acetate-free dialysate in patient with acute kidney ingury after cardiac surgery. NDT Plus 2010; 3 (suppl 3): iii367Mukhoedova T., Unarokov Z. Sustained low-efficiency daily dialysis with acetate-free dialysate in patient with acute kidney ingury after cardiac surgery. NDT Plus 2010; 3 (suppl 3): iii367Tonelli M., Astephen P., Andreou P., Beed S. Blood volume monitoring in intermittent hemodialysis for acute renal failure. Kidney Int 2002; 62: 1075-1080Tonelli M., Astephen P., Andreou P., Beed S. Blood volume monitoring in intermittent hemodialysis for acute renal failure. Kidney Int 2002; 62: 1075-1080Locatelli F., Buoncristiani U., Canaud B. et al. Haemodialysis with on-line monitoring equipment: tools or toys? Nephrol Dial Transplant 2005; 20(1): 22-33Locatelli F., Buoncristiani U., Canaud B. et al. Haemodialysis with on-line monitoring equipment: tools or toys? Nephrol Dial Transplant 2005; 20(1): 22-33Marshall M.R., Golper T.A., Shaver M.J. et al. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001; 60: 777-785Marshall M.R., Golper T.A., Shaver M.J. et al. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001; 60: 777-785Birne R., Branco P., Marcelino P. et al. A comparative study of cardiovascular tolerability with slow extended dialysis versus continuous haemodiafiltration in the critical patient. Port J. Nephrol Hypert 2009; 23(4): 323-330Birne R., Branco P., Marcelino P. et al. A comparative study of cardiovascular tolerability with slow extended dialysis versus continuous haemodiafiltration in the critical patient. Port J. Nephrol Hypert 2009; 23(4): 323-330Naka T., Baldwin I., Bellomo R. et al. Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians. Int J. Artif Organs 2004; 27(5): 380387Naka T., Baldwin I., Bellomo R. et al. Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians. Int J. Artif Organs 2004; 27(5): 380387Yegenaga I., Vanholder R., Hoste E. et al. Study of hemodynamic disturbances during slow extended daily hemodialysis vs continuous renal replacement therapy in acute renal failure patients in the intensive care unit. Blood Purif 2004; 22: 240-241Yegenaga I., Vanholder R., Hoste E. et al. Study of hemodynamic disturbances during slow extended daily hemodialysis vs continuous renal replacement therapy in acute renal failure patients in the intensive care unit. Blood Purif 2004; 22: 240-241Lima E.Q., Fernandes A., Zanon J. et al. Preventing intradialytic hypotension in acute kidney ingury patients submitted to slow low efficiency dialysis (SLED). Blood Purif 2008; 26: 179-180Lima E.Q., Fernandes A., Zanon J. et al. Preventing intradialytic hypotension in acute kidney ingury patients submitted to slow low efficiency dialysis (SLED). Blood Purif 2008; 26: 179-180Fieghen H.E., Friedrich J.O., Burns K.E. et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol 2010; 11: 32Fieghen H.E., Friedrich J.O., Burns K.E. et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol 2010; 11: 32

The authors declare that there are no conflicts of interest present.