Clinical Experience with a 39 Mmol/L Bicarbonate-Buffered Peritoneal Dialysis Solution

Abstract

Objective To investigate the effect on the patient's acidbase status of a 39 mmol/L bicarbonate-buffered continuous ambulatory peritoneal dialysis (CAPD) solution. Design This was an open, controlled, cross-over, two-center study in 9 patients. After three months of treatment with a 34 mmol/L bicarbonate-buffered solution (to) patients were switched to a 39 mmol/L bicarbonate-containing solution for four weeks. At the end of the study period (t4) patients were again treated with a 34 mmol/L bicarbonate-buffered CAPD solution for one month (t8). Results Mean venous plasma bicarbonate level significantly increased during the study and decreased at the baseline level during the control period (to = 22.94±2.54, t1 = 26.74±3.07, t2=28.47±2.68, t3=28.11±3.56, t4=28.71±3.27, t8=24.94±2.56). Arterial blood pH and plasma bicarbonate significantly increased during the study and significantly decreased attheend of the control period (pH: to= 7.37±0.04, t4= 7.42±0.04, t8= 7.37±0.06. Bicarbonate: t0= 21.97±2.57, t4= 25.85±2.02, t8= 21.87±2.89). The changes in plasma bicarbonate during the study period were inversely correlated with the metabolic acid production calculated from the protein catabolic rate and with the apparent distribution space for bicarbonate (ABS) of patients. Conclusions The 39 mmol/L bicarbonate-buffered CAPD solution improved the patient's acid-base status. Potential undesirable metabolic alkalosis could be prevented by analyzing the ABS and the metabolic acid production of patients.

Biocompatibility and buffers: Effect of bicarbonate-buffered peritoneal dialysis fluids on peritoneal cell function

“…The clinical studies performed thus far or that are currently underway do not systematically address this question. However, as far as initial observations go, a major difference in peritonitis rates between alternative and conventional solutions has not yet been observed [31][32][33][34][35]. An important issue regarding long-term outcome will be the potential impact of the dialysis fluids on the incidence of peritoneal sclerosing syndromes and ultrafiltration failure.…”

Bicarbonate Buffers in Peritoneal Dialysis

“…Therefore, a pilot study with 39 m M bicarbonate‐containing fluids followed. This study showed that patients whowere still acidotic with 34 m M bicarbonate reached normal venous andarterial blood bicarbonate values with 39 m M bicarbonate( 20). A European multicenter study in evaluation at presentseems to confirm this result.…”

Biocompatible peritoneal dialysis solutions: do they indeed affect the outcome?

“…24,47 The clinical disadvantages of dialysis solu tions with physio logical pH occur very seldom and include meta bolic alkalosis, occasionally ob served with solutions containing higher bic lev els (39 mmol/l). 48 Combined effects of the PG -ds, AA -ds and neutral pH/low GdP solution Trials designed to show the advantages of PG DS, AA DS combined with those of neutral solutions have been pub lished. 43,49 Treatment of new CAPD patients with the AA DS for 1 exchange, the PG DS for 1 ex change and neutral solutions for 2 remaining ex changes daily for 30 weeks did not result in sig nificant differences in dialysis efficiency, ultrafil tration, body weight, blood pressure, urine vol ume and laboratory blood tests, including hemo globin, sodium, potassium, calcium, phosphorus, Wyniki licznych badań potwierdziły korzystne działanie płynu do dializy otrzewnowej zawierającego polimery glukozy (polyglucose dialysis solution -PG-DS), płynu zawierającego aminokwasy (amino acid dialysis solution -AA-DS) oraz płynów buforowanych wodorowęglanem (bicarbonate -bic) lub bic z dodatkiem mleczanów (bicarbonate/lactate -bic/lac) na wybrane składowe bio zgodności otrzewnowej lub kliniczne para metry chorych leczonych dializą otrzewnową (peritoneal dialysis -PD).…”