Acidosis Correction with a new 25 Mmol/L Bicarbonate/15 Mmol/L Lactate Peritoneal Dialysis Solution

Abstract

Objective The aim of this study was to evaluate the effects of a combined 25 mmol/L bicarbonate/15 mmol/L lactate-based solution (Bic/Lac), compared to a 35 mmol/L lactate solution (Lac) — the most commonly used solution for patients in southern Europe — on the venous plasma bicarbonate level in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design This was a randomized, parallel, controlled, open-label study, with patients studied for a period of 3 months preceded by a 1-month baseline and followed by a 1-month follow-up. Patients used the 35 mmol/L lactate solution during baseline and follow-up periods. Setting Four Spanish nephrology centers. Patients Thirty-one (20 Bic/Lac, 11 Lac) well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) CAPD patients. Interventions Blood samples were taken for biochemistry tests at all visits. A physical examination was completed at baseline and month 3, and a medical update was completed after 1, 2, and 3 months, and at the follow-up visit. Adverse-event monitoring and notation of prescription changes were carried out continuously. Main Outcome Measure Effect on venous plasma bicarbonate level. Results Venous plasma bicarbonate rose by 3.1 mmol/L (confidence intervals 1.6 – 4.8), from a baseline level of 23.0 mmol/L during the treatment period in those patients treated with Bic/Lac ( p < 0.05 vs Lac). The number of acidotic patients (venous plasma bicarbonate < 24 mmol/L) was statistically significantly reduced at every treatment period visit in the Bic/Lac group ( p < 0.05). There were no adverse findings with respect to vital signs, physical examination, or clinical symptoms, apart from one death in the control group. Conclusions The new Bic/Lac solution allowed better correction of acid–base status than the lactate solution.

Clinical Experience with a New Bicarbonate (25 Mmol/L)/Lactate (10 Mmol/L) Peritoneal Dialysis Solution

“…In a previous study, patients were switched from a pure 35mmol/L lactate solution to a higher total buffer (40mmol/L) 25mmol/L bicarbonate/15mmol/L lactate mix (14). Because of the higher buffer level in the bicarbonate/lactate solution, it was predicted that the venous plasma bicarbonate levels would rise when patients were switched, and this was indeed observed: a rise in venous plasma bicarbonate of around 3mmol/L w as seen.…”

Consequences and therapy of the metabolic acidosis of chronic kidney disease

“…In patients who fail to raise serum [HCO 3 − ] to the desired level in response to the higher dialysate HCO 3 − , the addition of oral base is usually effective. In the majority of continuous ambulatory peritoneal dialysis patients, acid–base parameters can be maintained within the normal range with the conventional 35 mEq/l lactate-based dialysate, although some studies suggest a better correction of acidosis with the 25 mEq/l bicarbonate/15 mEq/l lactate dialysate [ 101 ]. As with hemodialysis patients, those who fail to raise serum [HCO 3 − ] to the desired level will usually respond to the addition of oral base.…”

Correction of chronic metabolic acidosis for chronic kidney disease patients

“…In PD there have been some trials which have evaluated the e ect of bu ering the unphysiologic acidic PD dialysis fluid in all patients not just those with acidosis (e.g. Carrasco 2001;Cooker 2001;Jones 2002;Stein 1997). Primary outcomes have o en been markers of intra-peritoneal inflammation.…”