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Abstract
The study was carried out as a randomized clinical trial, where , 60 patients, fulfilling the enrollment criteria, were randomly allocated to receive one of two methods for initiation of dialysis therapy The conventional incremental approach, with stepwise increase of duration of sessions (the control, group A).2- Extended low clearance, low . Capacity dialysis session (experimental group B)”This study aimed to evaluate the efficacy and safety of this approach for initiation of dialysis in the severely azotemic patients. The study population, were patients appeared to the emergency room of Suez Canal University Hospital with severe metabolic acidosis with arterial blood pH < 7.15 and serum bicarbonate? 10 mEq/ L due to renal failure, who were in urgent need to start renal replacement therapy . Group A patients initiated their dialysis program by three11, sessions at 1, 2 and 3 hours duration, respectively, using a 1.3 square meter surface area hemophan dialyzer. Whereas group B J patients initiated dialysis in an extended single session, hoursduration, using small surface area dialyzers (0.3 - 0.5 square meter surface area). Blood samples and vital signs were examined at 0, 24 and 48 hours of initiation dialysis therapy In both groups, a highly ’Significant improvement was observed in the 24 hour measurements of arterial blood pH. At this time point, significantly higher levels . of sodium bicarbonate concentration were evident in group B, compared with group A. By the end of the period of observation, measurements of all blood gas parameters were statistically comparable in the two groups, so that one infers that acidosis was corrected to the same extent in each group of patients.