Long-Term Clinical Experience with Pure Bicarbonate Peritoneal Dialysis Solutions

Abstract

Objectives The aim of this prospective study was to collect long-term experience in incident peritoneal dialysis (PD) patients treated with pure bicarbonate-buffered PD fluids. Methods The metabolic parameters acidosis, acid–base status, adequacy, fluid balance, nutritional markers, calcium, phosphorus, parathyroid hormone (PTH), and general laboratory work and medication were compared between incident PD patients in two groups: one treated with a 34 mmol/L bicarbonate-buffered PD fluid (BIC), the other with a 35 mmol/L lactate-buffered PD fluid (LAC). The observation period included 5 visits from 1 month (visit 1) until 12 months (visit 5) after the start of dialysis treatment. For the descriptive analysis, means and standard deviations were calculated. Student's t-test and linear mixed models were used to compare the two treatment groups. Results 36 patients were followed for 12 months, 18 in the BIC group and 18 in the LAC group. Statistically significant differences between the groups (at the end of study) were found. In BIC group, venous plasma bicarbonate was 27.4 ± 2.3 mmol/L, base excess 0.8 ± 2.2 mmol/L, and pH 7.31 ± 0.05; in LAC group, venous bicarbonate was 25.9 ± 2.4 mmol/L, base excess –0.6 ± 2.1 mmol/L, and pH 7.30 ± 0.04. No patient from the BIC group needed oral bicarbonate, in contrast to 4 patients in the LAC group. Whereas peritoneal urea and creatinine clearances did not differ between the groups, there was better renal solute clearance in the BIC group, accompanied by better-preserved diuresis at 12 months (1333 ± 935 mL with BIC vs 839 ± 556 mL with LAC). The reverse was true for ultrafiltration. Conclusions Pure bicarbonate-buffered PD solutions were superior in correcting metabolic acidosis and they allowed omission of oral bicarbonate. The minor ultrafiltration with bicarbonate-buffered PD solutions was counterbalanced by better-preserved residual renal function with these solutions.

Comparison between Bicarbonate/Lactate and Standard Lactate Dialysis Solution in Peritoneal Transport and Ultrafiltration: A Prospective, Crossover Single-Dwell Study

“…The transport of other solutes, including uric acid, calcium, phosphate, total protein, and beta 2-microglobulin, did not differ between these two solutions. This is in keeping with the majority of previous studies (10,11,16,19-22).…”

Strategies for preserving residual renal function in peritoneal dialysis patients

“…(2004) [ 66 ] 6-month randomized crossover Prevalent 86 CAPD subjects Yes Renal CrCl and urea clearance increase when using balance solution and decrease when using standard solution Montenegro et al . (2006) [ 79 ] 1-year randomized controlled trial Incident 36 CAPD, 18 (lactate base), 18 (bicarbonate base) Yes GFR decline in lactate base group, but preserved in bicarbonate group Szeto et al . (2007) [ 70 ] 1-year randomized controlled trial Incident 25 conventional, 25 neutral No Fan et al .…”

Benefits of preserving residual renal function in peritoneal dialysis

“…98 The use of other neutral and physiologic pH, low-glucose degradation product PD solutions resulted in higher urine volume although accompanied by a lower peritoneal UF. 99,100 In summary, the idea that dialysis may totally replace native renal function has never gained acceptance in the nephrology community. Even a malfunctioning kidney is able to carry out functions that go well beyond the capacities of dialysis therapy such as the regulation of the internal environment.…”