Trial of bicarbonate replacement solution alone in hemofiltration of two patients with unstable hemodynamics

Acetate replacement fluid is mainly used to alkalinize the buffer in ultrafiltration methods. However, the acetate solution has unfavorable effects, such as hypotension, in various hemopurifications. In this study, we wish to propose a new method of supplying bicarbonate and electrolyte separately. We applied our original bicarbonate solution as an alkali-buffer replacement fluid in two patients who had shown unstable hemodynamics during hemopurifications. Hemodynamics with bicarbonate solution was judged to be superior to acetate and lactate solutions according to all parameters methods. We emphasize that our new replacement fluid is completely free of acetate and offers the advantage of acetate-free biofiltration proposed by Zucchelli et al. The new, previously undescribed ultrafiltration method using bicarbonate alone is confirmed by myocardial scintigraphy to be hemodynamically superior to the traditional methods with acetate and lactate solutions.