Bicarbonate and bicarbonate/lactate peritoneal dialysis solutions for the treatment of infusion pain

Mactier, Robert; Sprosen, Timothy S.; Gokal, Ram; Williams, Paul F.; Lindbergh, Marianne; Naik, R. B.; Wrege, Ulf; Grontoft, Knut-Christian; Larsson, Robert; Berglund, J. Andrew; Tranæus, Anders; Faict, Dirk

doi:10.1046/j.1523-1755.1998.00849.x

Cited by 17 publications

(25 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another study looking at effects of neutral pH and low GDP compared with standard PD solutions in animals over a period of 2 years did not find significant differences in membrane transport characteristics, although the levels of inflammatory markers were lower in the neutral solution arm (81). Additionally, the combined bicarbonate/lactate solutions are observed to be effective in decreasing the infusion pain (82). Clinically, these neutral solutions can influence the RRF and ultrafiltration profile (83).…”

Section: Pd Solutions With Neutral Phmentioning

confidence: 99%

Biocompatible Peritoneal Dialysis Solutions

Chaudhary

Khanna

2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Clinical experience and literature evidence suggest that peritoneal dialysis (PD) is a safe and effective treatment in short term (3 to 5 years) for stage 5 chronic kidney disease patients. A major limitation to long-term PD has been peritoneal membrane structural and functional alterations over time, resulting in significant technique failure. Much evidence implicates glucose contained in conventional PD solutions as the major cause of membrane changes. Other harmful characteristics of glucose or its degradation products are thought to cause systemic undesirable metabolic and cardiovascular effects. This led to the search for more "biocompatible" PD solutions to ameliorate complications associated with conventional glucose solutions. Studies in animals and humans show that newer biocompatible solutions may preserve membrane functions better, lead to less therapy failure, and avoid the undesirable metabolic and cardiovascular effects of systemic glucose exposure. There is evidence in specific, clinical, short-term situations of biochemical and metabolic benefits of biocompatible solutions. However, are these solutions superior to glucose in preserving peritoneal membrane long term? Are they truly more biocompatible? Clinical and experimental data suggest that newer solutions, albeit most of them glucose based, are less toxic compared with the current PD solution; however, there is currently no osmotic agent that can safely replace glucose. The future appears to be in using combinations of different osmotic agents in a more biocompatible solution, whether they are mixtures in a single bag or daily exchanges of different osmotic agents. This review discusses the current status of these biocompatible solutions in PD patients.Clin J Am Soc Nephrol 5: 723-732, 2010. doi: 10.2215/CJN.05720809 P eritoneal dialysis (PD) has been an accepted form of renal replacement therapy (RRT) for end-stage renal disease patients (1). Conventional PD solutions contain dextrose as the osmotic agent. Absorbed glucose is metabolized and is used as a source of energy. However, long-term systemic exposure of glucose has been well recognized to cause metabolic and cardiovascular abnormalities, which contribute to some of the morbidities seen in PD patients. PD solutions have a shelf life, and the glucose over time degrades to form glucose degradation products (GDPs), which have been implicated in a variety of adverse effects on the peritoneal membrane, in addition to the well known other systemic effects. Several studies both in vivo and in vitro have shown that conventional solutions damage the mesothelial cells lining the peritoneum, cause peritoneal membrane thickening, and lead to changes of the peritoneal blood vessels (2,3). The dextrose-based solutions have been shown to cause structural as well as functional changes in the peritoneal membrane, which in long-term patients ultimately leads to ultrafiltration failure and discontinuation of PD (4,5). The glucose-based solutions do not contain bicarbonate, which is substituted with the ...

show abstract

Section: Pd Solutions With Neutral Phmentioning

confidence: 99%

Biocompatible Peritoneal Dialysis Solutions

Chaudhary

Khanna

2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Recent studies have proposed that a mixture of Bic/Lac may be more biocompatible than a solution comprised of bicarbonate alone, although bicarbonate has been well established to be an ideal buffer for PD (14,15). In addition, the Bic/Lac solution appears to be more effective than pure bicarbonate solution in correcting infusion pain in PD patients (16). Tranaeus et al showed that the Bic/Lac solution is safe and effective in correcting uremic acidosis, providing relief of inflow pain/discomfort and improving ultrafiltration and body weight (9).…”

Section: Discussionmentioning

confidence: 99%

Effects of Dialysis Solution on the Cardiovascular Function in Peritoneal Dialysis Patients

et al. 2015

View full text Add to dashboard Cite

Objective Peritoneal dialysis (PD) patients have an increased cardiovascular burden. In this study, we aimed to compare certain PD solutions (Physioneal and Dianeal ) in terms of the ambulatory blood pressure, echocardiographic parameters (ECHO), carotid atherosclerosis, endothelial function and serum asymmetric dimethylarginine (ADMA) level. Methods A total of 45 PD patients were enrolled in this prospective randomized controlled study: 23 patients in the Dianeal group and 22 patients in the Physioneal group. Ambulatory blood pressure measurements, echocardiography, carotid artery intima-media thickness measurements and flow mediated dilatation (FMD) and ADMA values were obtained at baseline and 12 months. Results The baseline parameters were similar between the groups with respect to the echocardiographic parameters, 24-hour ambulatory blood monitoring measurements and ADMA and FMD levels. All 24-hour blood pressure monitoring measurements, except for the average daytime systolic blood pressure, were significantly decreased in both groups at the first year. In the Physioneal group, a significant decrease was observed with regard to the ADMA levels. Considering the FMD values, significant augmentation was seen at the end of the first year in both groups. Improvements in the FMD measurements were prominent in the Physioneal group; however, this finding was not statistically significant. Conclusion The use of solutions with a neutral pH in PD patients results in decreased ADMA levels, which may be an important contributor to reductions in the incidence of cardiovascular events and deaths in this population.

show abstract

“…Acidic PD fluid promotes mesothelial cell damage and neoangiogenesis in vitro (3) and infusion pain in the clinical setting (4). Exposure to GDPs also results in reduced growth and viability of peritoneal cell populations (mesothelial cells, fibroblasts, macrophages, and leukocytes), increased collagen deposition, augmented secretion of proinflammatory cytokines such as vascular endothelial growth factor, local production of damaging advanced glycation endproducts (AGEs) (5), and stimulation of epithelialmesenchymal transition (6)(7)(8)(9).…”

Section: Trials (And Tribulations) Of Biocompatible Peritoneal Dialysmentioning

confidence: 99%

“…First, consistent changes in dialysate effluent markers of peritoneal integrity and inflammation appear to be demonstrated with the administration of biocompatible fluids, although the clinical significance of those changes remains uncertain. Second, there is clinical evidence that neutral-pH low-GDP fluids reduce infusion pain in PD patients (4). Third, biocompatible fluids maY 2012 -Vol.…”

Section: Trials (And Tribulations) Of Biocompatible Peritoneal Dialysmentioning

confidence: 99%