Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: A retrospective analysis

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Abstract

Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass. Methods: Single-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- A nd post-Z-BUF-D. Secondary outcomes included changes in pre- A nd post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S). Results: Z-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure. Conclusion: Z-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

Original languageEnglish (US)
Article number163
JournalJournal of Cardiothoracic Surgery
Volume14
Issue number1
DOIs
StatePublished - Sep 10 2019

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Dialysis Solutions
Ultrafiltration
Bicarbonates
Sodium Bicarbonate
Cardiopulmonary Bypass
Sodium Chloride
Potassium
Hyperkalemia
Injections
Acidosis
Serum
Thoracic Surgery
Uncertainty

Keywords

  • Dialysate
  • Z-BUF
  • Zero balance ultrafiltration

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{8af97e40bd62485999bea794faf8042a,
title = "Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: A retrospective analysis",
abstract = "Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4{\%} sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4{\%} sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass. Methods: Single-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- A nd post-Z-BUF-D. Secondary outcomes included changes in pre- A nd post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S). Results: Z-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4{\%} sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure. Conclusion: Z-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.",
keywords = "Dialysate, Z-BUF, Zero balance ultrafiltration",
author = "Ryan Mullane and Lance Fristoe and Markin, {Nicholas W.} and Brakke, {Tara R.} and Merritt-Genore, {Helen Mari} and Aleem Siddique and Miles, {Clifford D.} and Plumb, {Troy J.}",
year = "2019",
month = "9",
day = "10",
doi = "10.1186/s13019-019-0986-8",
language = "English (US)",
volume = "14",
journal = "Journal of Cardiothoracic Surgery",
issn = "1749-8090",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage

T2 - A retrospective analysis

AU - Mullane, Ryan

AU - Fristoe, Lance

AU - Markin, Nicholas W.

AU - Brakke, Tara R.

AU - Merritt-Genore, Helen Mari

AU - Siddique, Aleem

AU - Miles, Clifford D.

AU - Plumb, Troy J.

PY - 2019/9/10

Y1 - 2019/9/10

N2 - Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass. Methods: Single-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- A nd post-Z-BUF-D. Secondary outcomes included changes in pre- A nd post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S). Results: Z-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure. Conclusion: Z-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

AB - Background: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass. Methods: Single-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- A nd post-Z-BUF-D. Secondary outcomes included changes in pre- A nd post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S). Results: Z-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure. Conclusion: Z-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

KW - Dialysate

KW - Z-BUF

KW - Zero balance ultrafiltration

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U2 - 10.1186/s13019-019-0986-8

DO - 10.1186/s13019-019-0986-8

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VL - 14

JO - Journal of Cardiothoracic Surgery

JF - Journal of Cardiothoracic Surgery

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