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[Improvement of dialysis tolerance in patients with severe infections using a bicarbonate dialysate].

Severe septic patients, with high cardiac output (CO) and low systemic arterial resistances (SAR), often develop an uncontrolled fall in blood pressure (BP) during acetate hemodialysis (AcHD), because they are especially unable to increase appropriately their SAR with fluid removal. To investigate the possibility that Ac transfer plays a part in this fall in BP, we studied and compared hemodynamic and biochemistry status of such 10 patients with acute renal failure by alternately using Ac and bicarbonate (Bi) dialysate. CO and mean systemic arterial pressure decrease more during AcHD than during BiHD, whereas the changes in pulmonary wedge pressure were similar; heart rate and SAR remained unchanged. Thus the better hemodynamic tolerance during BiHD seems to be due to a change in myocardial contractility that may be related to differences in acid-base status and plasmatic potassium concentrations.