Comparative Physiology of Acetate and Bicarbonate Alkalinization

  • F. John Gennari


In 1964, acetate was introduced into dialysis therapy as a substitute for bicarbonate to overcome the technical problem of precipitation of carbonate salts in the bath (Mion et al., 1964). At that time, a few studies were carried out to demonstrate that acetate was indeed an effective source of alkali during dialysis, and then this organic anion rapidly replaced bicarbonate in dialysis baths. Only after a decade or more of widespread use of acetate in dialysis have physicians begun to examine in detail the implications of the substitution of acetate for bicarbonate (Kveim and Nesbakken, 1975; Tolchin et al., 1977; Graefe et al., 1978; Vreeman et al., 1980). These investigations increased our understanding of acid-base balance in dialysis patients. At the same time, however, some controversy has arisen. Acetate has been condemned by some, but as yet no one has uncovered convincing evidence that acetate use should be discontinued altogether.


Dialysis Patient Renal Tubular Acidosis Bicarbonate Concentration Acetate Metabolism Carbonate Salt 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ballard, F. J., 1972, Supply and utilization of acetate in mammals, Am. J. Clin. Nutr. 25:773.PubMedGoogle Scholar
  2. Bauer, W., and Richards, D. W., 1928. A vasodilator action of acetates, J. Physiol. 66:371.PubMedGoogle Scholar
  3. Brenes, L. G., Brenes, J. N., Rodrigues, V. M., and Hernandez, M. M., 1977, Familial proximal renal tubular acidosis. A distinct clinical entity, Am. J. Med. 63:244.PubMedCrossRefGoogle Scholar
  4. Gennari, F. J., and Cohen, J. J., 1978, Renal tubular acidosis, Annu. Rev. Med. 29:521.PubMedCrossRefGoogle Scholar
  5. Graefe, U., Milutinovich, J., Follette, W. C., Vizzo, J. E., Babb, A. L., and Scribner, B. H., 1978, Less dialysis-induced morbidity and vascular instability with bicarbonate in dialysate, Ann. Intern. Med 88:332.PubMedGoogle Scholar
  6. Kirkendol, P. L., Devia, C. J., Bower, J. D., and R. D. Holbert, 1977, A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions, Tr. Am. Soc. Artif. Intern. Organs 23:399.CrossRefGoogle Scholar
  7. Kveim, M., and Nesbakken, R., 1975, Utilization of exogenous acetate during hemodialysis, Tr. Am. Soc. Artif. Intern. Organs 21:138.Google Scholar
  8. Lipsky, S., Alper, B., Rubini, M., Van Eck, W., and Gordon, M., 1954, The effects of alkalosis upon ketone body production and carbohydrate metabolism in man, J. Clin. Invest. 33:1269.PubMedCrossRefGoogle Scholar
  9. Lundquist, F., 1962, Production and utilization of free acetate in man, Nature 193:579.PubMedCrossRefGoogle Scholar
  10. Mion, C. M., Hegstrom, R. M., Boen, S. T., and Scribner, H. B., 1964, Substitution of sodium acetate for sodium bicarbonate in the bath fluid for hemodialysis, Tr. Am. Soc. Artif. Intern. Organs 10:110.Google Scholar
  11. Mudge, G. H., Manning, J. A., and Gilman, A., 1949. Sodium acetate as a source of fixed base, Proc. Soc. Exp. Biol. Med. 71:136.PubMedGoogle Scholar
  12. Raja, R., Kramer, M., Rosenbaum, J. L., Bolisay, C. and Krug, M., 1980, Prevention of hypotension during iso-osmolar hemodialysis with bicarbonate dialysate, Tr. Am. Soc. Artif Intern. Organs 26:375.Google Scholar
  13. Tolchin, N., Roberts, J. L., Hayashi, J. and Lewis, E. J., 1977, Metabolic consequences of high mass-transfer hemodialysis, Kidney Int. 11:366PubMedCrossRefGoogle Scholar
  14. Vreeman, H. J., Assomull, V. M., Kaiser, B. A., Blaschke, T. F., and Weiner, M. W., 1980, Acetate metabolism and acid-base homeostasis during hemodialysis: Influence of dialyzer efficiency and rate of acetate metabolism, Kidney Int. 18(suppl. 10): S62.Google Scholar

Copyright information

© Plenum Publishing Corporation 1985

Authors and Affiliations

  • F. John Gennari
    • 1
  1. 1.Department of MedicineUniversity of Vermont College of MedicineBurlingtonUSA

Personalised recommendations