Effect of the Dialysis Fluid Buffer on Peritoneal Membrane Function in Children

Abstract

SummaryBackground and objectives Double-chamber peritoneal dialysis fluids exert less toxicity by their neutral pH and reduced glucose degradation product content. The role of the buffer compound (lactate and bicarbonate) has not been defined in humans.Design, setting, participants, & measurements A multicenter randomized controlled trial in 37 children on automated peritoneal dialysis was performed. After a 2-month run-in period with conventional peritoneal dialysis fluids, patients were randomized to neutral-pH, low-glucose degradation product peritoneal dialysis fluids with 35 mM lactate or 34 mM bicarbonate content. Clinical and biochemical monitoring was performed monthly, and peritoneal equilibration tests and 24-hour clearance studies were performed at 0, 3, 6, and 10 months.Results No statistically significant difference in capillary blood pH, serum bicarbonate, or oral buffer supplementation emerged during the study. At baseline, peritoneal solute equilibration and clearance rates were similar. During the study, 4-hour dialysis to plasma ratio of creatinine tended to increase, and 24-hour dialytic creatinine and phosphate clearance increased with lactate peritoneal dialysis fluid but not with bicarbonate peritoneal dialysis fluid. Daily net ultrafiltration, which was similar at baseline (lactate fluid=5.462.6 ml/g glucose exposure, bicarbonate fluid=4.961.9 ml/g glucose exposure), decreased to 4.661.0 ml/g glucose exposure in the lactate peritoneal dialysis fluid group, whereas it increased to 5.161.7 ml/g glucose exposure in the bicarbonate content peritoneal dialysis fluid group (P=0.006 for interaction).Conclusions When using biocompatible peritoneal dialysis fluids, equally good acidosis control is achieved with lactate and bicarbonate buffers. Improved long-term preservation of peritoneal membrane function may, however, be achieved with bicarbonate-based peritoneal dialysis fluids.

Monocarboxylate Transporter‐1 Mediates the Protective Effects of Neutral‐pH Bicarbonate/Lactate‐Buffered Peritoneal Dialysis Fluid on Cell Viability and Apoptosis

“…Previous studies have primarily focused on the effects of B/L‐PDF on HPMC survival, peritoneal fibrosis, and epithelial‐mesenchymal transition . HPMC viability is also reportedly reduced by decreased adenosine 5′‐triphosphate levels and inhibition of mitochondrial activity . Our study revealed that L‐PDF containing a high lactate concentration induces apoptosis in HPMCs, with a concomitant decrease in cell number, suggesting that cell injury from high lactate concentrations is caused by apoptosis rather than cell cycle arrest (Figs and ).…”

Is there such a thing as biocompatible peritoneal dialysis fluid?

“…Since then, some new clinical data have been reported in the pediatric population. A prospective randomized comparison of low GDP fluids revealed better preservation of UF capacity with bicarbonate versus lactate buffer [ 35 ]. Moreover, prospectively collected data in the IPPN suggests improved longitudinal growth in infants treated with low GDP fluids, potentially due to attenuated local and systemic inflammatory and carbonyl stress.…”

Bicarbonate buffered peritoneal dialysis fluid upregulates angiopoietin-1 and promotes vessel maturation

“…A recent trial demonstrated lower ultrafiltration rates during the first 6 months of PD with fluids with low glucose degradation product content but better preservation of long term PD function as compared to the acidic PD fluids with high glucose degradation product content [ 6 ]. A randomized trial comparing two neutral pH PD fluids with low glucose degradation product content containing either lactate or bicarbonate buffer over 10 months yielded better preservation of ultrafiltration capacity with the bicarbonate PD fluid [ 7 ].…”