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

Abstract

Objective Physiological bicarbonate/lactate-based solutions may correct acidosis in a better way than standard lactate-based solutions. In this study, a new 25 mmol/L bicarbonate/10 mmol/L lactate peritoneal dialysis (PD) solution was compared with a standard 35 mmol/L lactate solution. Design This was a prospective open label study. All patients had a 2-week baseline period using the standard lactate solution, followed by 8 weeks on the bicarbonate/lactate solution and 2 weeks on the lactate-basedsolution. Setting Four Danish and four Spanish nephrology centers. Patients 40 well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) patients on continuous ambulatory PD. Interventions Blood samples were taken for biochemistry (including venous blood gases) at week –2, day 1, weeks 2, 4, and 8, and at follow-up. A physical examination, a peritoneal equilibration test (PET), and quality of life (K/DQOL), ultrafiltration, and adequacy assessments were performed at baseline and at week 8. Vital signs and other safety parameters were followed at each visit. Extraneal (Baxter Healthcare, Castlebar, Ireland) was used by all patients for the long dwell. Main Outcome Measure Effect on the venous plasma bicarbonate level. Results Venous plasma bicarbonate levels rose from 24.4 mmol/L when patients were on the pure lactate to 26.1 mmol/L when using the bicarbonate/lactate solution ( p < 0.001). When patients were using the bicarbonate/lactate solution, 66% of values were maintained within the venous normal range of 24 – 30 mmol/L, versus 46.2% when patients were on the pure lactate solution ( p < 0.001). There were no adverse findings with respect to clinical symptoms, vital signs, or physical examination. The PET and adequacy, ultrafiltration, and K/DQOL assessment results were unchanged. Conclusions The new 25 mmol/L bicarbonate/10 mmol/L lactate solution provided better correction of acidosis than an equivalent 35 mmol/L standard lactate solution, without any safety issues.

Longer‐Period Effects of Bicarbonate/Lactate‐Buffered Neutral Peritoneal Dialysis Fluid in Patients Undergoing Peritoneal Dialysis

“…The serum bicarbonate level and pH decreased with use of the bicarbonate/lactate‐buffered neutral PDF, and the former fall within reference interval and the latter were maintained at the physiologic level during the study period. It previously demonstrated that serum bicarbonate level rose by 1.5 mEq/L when patients were switched from a 35 mEq/L lactate PDF to a 25 mEq/L bicarbonate/10 mEq/L lactate mixed PDF (total buffer 35 mEq/L) , but in the present study the buffer was decreased from a 40 mEq/L lactate to a 25 mEq/L bicarbonate/10 mEq/L lactate (total 35 mEq/L) and therefore serum bicarbonate level might decreased. Additionally, the serum lactate level and anion gap did not change.…”

PD solutions: New and old

“…Other studies with newer, biocompatible PD solutions showed no advantage over conventional solutions in relation to peritoneal membrane transport. 80,81,88…”

A new peritoneal dialysis fluid for Japanese patients: a randomized non-inferiority clinical trial of safety and efficacy

“…This important association was stronger in patients with longer dialysis vintage, suggesting cumulative harm over extended exposure, a finding of direct relevance to Japanese dialysis populations given their longevity. Overall, it seems appropriate to avoid chronic alkalosis from over-correction by the high alkaline content of PDF, and individualize PDFs to provide appropriate alkaline content as appropriate [ 37 , 38 ].…”