Ultrafiltration and the Buffer: One More Interaction to Consider?

The Composition of Peritoneal Dialysis Solutions: Tinkering or Significant Changes?

“…What is the impact of allowing the fluid to be completely reabsorbed? Some authors would argue that there may be a beneficial effect of regular exchanges to reduce inflammatory mediators (12), and if citrate were truly protective, the beneficial effects would be more readily apparent with continuous exposure.…”

“…Before the use of citrate to replace or reduce lactate as a buffer, it would be important to understand the potential metabolic changes that might occur. In an earlier commentary, Holmes gave the example of acetate used as an alternative buffer to lactate: acetate initially appeared to be as efficacious as lactate but was subsequently shown to actually enhance the loss of UF (12). Clearly, more studies are required to accurately determine just what impact the addition of citrate to dialysis fluids might have before it could safely be considered a dialysate buffer.…”