We evaluated the feasibility of using L-lactate as a base for hemodialysis. In one study, acid-base changes using 40 mM L- or DL-lactate were compared. In a second study, acid-base status using various amounts of L-lactate exclusively was studied. The third study compared symptoms and acid-base changes during 9 weeks of high-efficiency dialysis when using L-lactate, acetate, or bicarbonate as base. In the first study, plasma bicarbonate changes were equivalent with 40 mM L-lactate and 40 mM DL-lactate, but overall correction of acidosis appeared to be suboptimal. In the second study, when compared to a bicarbonate control period, correction of acidosis was reduced when using 40 mM L-lactate + 4 mM acetate solution, but increased when using a 46 mM L-lactate + 4 mM acetate solution. In the third study, correction of acidosis was comparable when using 42 mM L-lactate + 4 mM acetate, 39 mM acetate, or 35 mM HCO3 + 4 mM acetate. Whereas 46% +/- 12 (SEM) treatments "failed" because of symptoms when using acetate, the percentages of "failed" treatments were only 7% +/- 4.2 with L-lactate (p less than 0.05) and 11% +/- 4.2 with bicarbonate (p less than 0.05). The results suggest that L-lactate is a suitable dialysis solution base that is capable of correcting chronic uremic acidosis. During high-efficiency dialysis, the incidence of intradialytic symptoms with L-lactate is comparable to that with bicarbonate and less than that with acetate.
The usefulness of colon‐cancer screening using stool‐guaiac testing has been established in large control populations, but not in dialysis patients. In 72 asymptomatic dialysis patients [51 treated with hemodialysis (HD), and 21 with peritoneal dialysis (PD)] who underwent outpatient stool occult blood testing, the test result was positive in 11 (15%) patients (8 HD and 3 PD). Eight of the 11 were investigated further by colonoscopy and, when deemed necessary by the treating physician, esophago‐gastroduodenoscopy and/or barium enema were also performed. A site of active bleeding was identified in three of the eight patients (hemorrhoids, telangiectasia, ulcerative colitis). In each of the five other patients, potentially bleeding lesions were identified: colonic polyps (two malignant and two benign) in four patients, Barrett's esophagus in one, diverticulosis in two, and colonic vascular deformities in two. These results were compared with those of a large ongoing fecal occult blood screening program in which the prevalence of positive stool occult blood tests is 5% and in which 42% of the positive patients have colonic neoplasms. Thus, although the baseline incidence of positive guaiac tests may be higher in dialysis patients than in nonuremic controls, our results suggest that stool guaiac testing of dialysis patients may not only be useful in detecting colonic polyps, but may also identify other previously unsuspected causes of gastrointestinal bleeding.
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