Comparative Physiology of Acetate and Bicarbonate Alkalinization
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.
KeywordsDialysis Patient Renal Tubular Acidosis Bicarbonate Concentration Acetate Metabolism Carbonate Salt
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