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Bicarbonate Dialysis

Passed by the NKF September 1997 (Amended 2008)

The National Kidney Federation supports the universal use of bicarbonate as the buffer base in haemodialysis fluid. Acetate (which is hardly ever used) should be phased out.


One of the functions of the human kidney is to regenerate bicarbonate. Haemodialysis (HD) replaces this function by including supraphysiological concentration of base in the dialysis fluid. In the early days the natural buffer, bicarbonate, was the obvious choice but there were technical problems with its preparation and delivery. In the mid 60s the introduction of acetate, which is metabolised to bicarbonate, solved many of these problems.

The disadvantage of acetate became apparent a decade later when improvement in the efficiency of HD revealed the potential for overwhelming the capacity of some patients to metabolise acetate.

Studies in the late 80s have shown less severe metabolic disturbance associated with the use of bicarbonate, leading to fewer intra-dialytic symptoms and thus to increased comfort during and after the HD session. Although no increment in patient survival has yet been demonstrated, bicarbonate has been widely accepted as the buffer of choice.