Do Bicarbonate-Based Solutions for Continuous Renal Replacement Therapy Offer Better Control of Metabolic Acidosis than Lactate-Containing Fluids?

Abstract

Introduction: Evidence that bicarbonate haemofiltration and dialysate fluids are superior to lactate in patients with acute kidney injury treated by continuous renal replacement therapy (CRRT) remains controversial. Methods: We prospectively audited acid-base during the first 48 h of CRRT in 62 patients, using bicarbonate and lactate fluids. Results: Baseline lactate was greater in the bicarbonate group (4.76 ± 0.77 vs. 2.92 ± 0.5 mmol/l, p < 0.01), but pH, bicarbonate, chloride and base excess were similar. Lactate fell significantly in the bicarbonate group to 2.88 ± 0.3 mmol/l at 24 h and 2.39 ± 0.2 mmol/l at 48 h, but not in the lactate group. Base excess improved more with bicarbonate, median increase in the first 24 h was 51.6% (29.1–96.9) versus 18.5% (–5 to 55) with lactate and 74.2% (38.5–123) versus 36.1% (–3.6 to 68), p < 0.05 at 48 h. However, there were no significant differences in bicarbonate, chloride, pH, blood pressure and vasopressor requirements. 13.3% of patients were switched from lactate to bicarbonate fluids due to failure to correct acidosis. Subgroup analysis of 19 patients with liver failure showed similar results. Conclusion: Bicarbonate fluids led to a more rapid fall in lactate and greater improvement in base excess during CRRT, but not overall control of acidosis.

Severe Malaria

“…Regarding the dialysate and haemofiltration fluid, a recent study showed that bicarbonate fluids led to a more rapid fall in lactate and greater improvement in base excess during CRRT, but not to an overall improvement in the control of acidosis (Agarwal et al . ). As a consequence, the use of bicarbonate buffer is now preferred.…”

Extracorporeal Treatment for Metformin Poisoning

“…Rationale: Intermittent hemodialysis was recommended as the first-line initial ECTR by the workgroup because it is superior in terms of its correction of acidemia and removal of metformin and lactic acid (144). Bicarbonate-based dialysate buffers are standard today and are preferable to acetate-based buffers that fail to correct serum bicarbonate as quickly (226,227); replacement or dialysate solutions containing lactate may delay correction of hyperlactatemia (211,(228)(229)(230). Bicarbonate-based dialysate buffers are standard today and are preferable to acetate-based buffers that fail to correct serum bicarbonate as quickly (226,227); replacement or dialysate solutions containing lactate may delay correction of hyperlactatemia (211,(228)(229)(230).…”

Handling Continuous Renal Replacement Therapy-Related Adverse Effects in Intensive Care Unit Patients: The Dialytrauma Concept

“…Lactate has an additional inconvenience since high replacement doses or impaired liver function may cause hyperlactatemia. The latter is not harmful in the absence of metabolic acidosis but may necessitate a switch to bicarbonate because failure to correct acidosis has been demonstrated in up to 13% of patients [22]. Studies of hepatic clearance using indocyanine green showed that hyperlactatemia related to lactate replacement fluid can unmask liver dysfunction.…”