Acetate versus Lactate in Peritoneal Dialysis Solutions

Abstract

The acid-base characteristics of two peritoneal dialysis solutions containing either lactate or acetate are compared and the time course of changes in intraperitoneal pH following instillation into the abdominal cavity is measured. The concentration of titratable acid (cTA) is 5.58 mmol/l or 7 times as high in solutions containing acetate as in those containing lactate (0.79 mmol/l). The buffer capacity, -dcTA/dpH, is 11.43 and 1.82 mmol/l, respectively. Following intraperitoneal instillation of 1.5 liter of the solutions, the time course is 2–3 times as long before intraperitoneal pH reaches 7 using acetate (18 min) as when using lactate (7 min). The above mentioned difference in acid-base characteristics as well as an individual acetate intolerance is supposed to be the cause for the development of abdominal pains and peritoneal irritation observed in some patients using acetate-containing solutions.123 mmol/l of sodium bicarbonate is to be added to the acetate solution to raise the pH value from 5.6 to 7.4. Neutralization using sodium bicarbonate will thus result in sodium intoxication of the patient. The use of lactate instead of acetate for peritoneal solutions is advocated.

Bicarbonate and bicarbonate/lactate peritoneal dialysis solutions for the treatment of infusion pain

“…For example, it has been reported that abdominal pain occurs in 78% of patients during an episode of peritonitis [4]. However, pain experienced during intraperitoneal infusion of the dialysis solution also occurs in the non-peritonitis state, and is distinguished by the abdominal pain appearing within the first minute or so after starting infusion of the PD solution, but which generally diminishes during the dwell [5]. Infusion pain is usually observed in new patients commencing dialysis and is often transient in nature, spontaneously disappearing over time [3,6].…”

Biocompatibility of a new PD solution for Japan, Reguneal™, measured as in vitro proliferation of fibroblasts

“…From in vivo experiments, it is known that the pH of PDFs is neutralized within a few minutes [33]. During this short window, however, the low pH that is inherent in conventional, one compartment, lactate-based PDFs may adversely affect mesothelial cells, by the lowering of intracellular pH and impairment of metabolism due to changed redox potentials [34,35].…”

Effects of Neutral pH and Reduced Glucose Degradation Products in a New Peritoneal Dialysis Solution on Morphology of Peritoneal Membrane in Rats

“…However, unlike the results of the in vitro studies, pH is not a major factor in the in vivo setting. Such a discrepancy is due to the fact that an acidic PDF is pH neutralized within 30 min after exposure to the peritoneal cavity [6, 7, 8]. It demonstrates that although pH can be a major factor that affects viability of cells in vitro, it does not affect them in vivo because of their biological buffering ability.…”

“…The acidic PD solution is neutralized within 30 min after being instilled into the abdominal cavity due to the large buffering capacity of the peritoneal membrane and of the intraperitoneal residual fluid [6, 7, 8]. It has been reported that an acidic pH has deleterious impacts on the host defense in the abdominal cavity and on the mesothelial cells [9, 10].…”