Effects of bicarbonate- and lactate-buffered replacement fluids on cardiovascular outcome in CVVH patients

Abstract

The results show that the administration of RF-bic solution was superior in normalizing acidosis of patients without the risk of alkalosis. The data also suggest that the use of RF-bic during CVVH reduces cardiovascular events in critically ill patients with acute renal failure, particularly those with previous cardiovascular disease or heart failure.

Renal replacement therapy review

“…[96][97][98] Lactate is noted to rise during lactate-based RRT and may have deleterious cardiovascular side effects and is associated with poor outcomes. 95,96,[98][99][100][101] It is unclear whether lactate induces injury or is simply a marker of dysoxia and abnormal liver metabolism of lactate during critical illness hence its association with mortality. Although some fluids still contain minimal lactate (~3 mEq), most fluids are bicarbonate (20-24 mEq/L) based.…”

Clinical Outcome Following the Use of Inadequate Solutions for Continuous Veno-Venous Hemodiofiltration

“…[7] This led to the assumption that exogenous lactate may be harmful and promoted the use of bicarbonate-buffered solutions. [4,8,9] The exogenous lactate load should be avoided in patients with lactic acidosis for two reasons: the decreased ability of the body to use lactate, and the better hemodynamic stability with bicarbonate. [4,10] We demonstrated that blood lactate and glucose levels were higher and bicarbonate and insulin requirements were higher in the PD group than that in the bic-HS group.…”

“…[4,8,9] The exogenous lactate load should be avoided in patients with lactic acidosis for two reasons: the decreased ability of the body to use lactate, and the better hemodynamic stability with bicarbonate. [4,10] We demonstrated that blood lactate and glucose levels were higher and bicarbonate and insulin requirements were higher in the PD group than that in the bic-HS group. Zimmerman et al [11] demonstrated that both lactate and bicarbonate-based solutions result in the same degree of effective clearance, but that plasma lactate levels are higher in patients on lactate-based dialysis solutions.…”

“…In addition, hyperlactatemia was associated with the development of metabolic acidosis caused by disturbed lactate metabolism and bicarbonate losses into the filtrate. Barenbrock et al [4] clearly showed bicarbonate-based solutions to be more beneficial than lactate-based solutions.…”

“…[3,4] There are three main modalities of renal replacement therapy for ARF treatment: peritoneal dialysis, traditional intermittent hemodialysis, and CRRT. [5,6] A few years ago, commercially available diafiltration and replacement fluid could not be found on the market in Turkey.…”