«On-line» Preparation of Bicarbonate-containing Dialysate for Use in Peritoneal Dialysis

Clinical Effects of Long-Term Use of Neutralized Dialysate for Continuous Ambulatory Peritoneal Dialysis

“…These problems can be solved by the use of 2 solutions to be mixed before use [12,14], The major difficulty in the clinical use of neutralized dialysate is the material of the dialysate bag. Polyvinylchloride is now used to make the bags, but it is unsuitable for the storage of solutions that contain bicarbonate or high levels of C 0 2.…”

“…There is no particularly suitable material for such use; however, lami nation has been tried for the prevention of gas permeation [18]. Our bicarbonate injection system is the same as the single-container method described elsewhere [14] and re quires a reconstitution device.…”

“…The pH of commercially available low pH, which also may damage the peritoneal membrane in the long term. Both the high lactate concentration and the low pH are improved if sodium bicarbonate is used instead of sodium lactate [10][11][12][13][14][15][16][17][18][19], but this is difficult because the stored dialysate and the bag become relatively unstable with the use of this compound. Neutralized dialysate has been used in the short term as part of the treatment of peritonitis in our hospital, but there are no studies of the long-term clinical use of such dialysate.…”

Lactate-Containing Peritoneal Dialysis Solutions

“…Subsequently, a sodium hydroxide or a sodium bicarbonate solution, kept in a piggy-back container (45,46) or in one compartment of a two-compartment bag (44), is mixed with the main solution just prior to dialytic use to create a final PDS that is euhydric or considerably less acidic. The mixing can be achieved by disrupting a partition separating the main solution from the base solution (44,(45)(46)(47). The final PDS so obtained will be more biocompatible to body cells.…”

Bicarbonate-Buffered Peritoneal Dialysis

“…Although relatively difficult to prepare and store, sterile peritoneal dialysis solutions containing bicarbonate, calcium and magnesium may at times be needed (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), For example, one may have to dialyze a uremic patient who has developed hypotension and lactic acidosis, In such a patient, the lactate or acetate in conventional dialysates may not be metabolized to bicarbonate because of tissue hypoxia, and acidosis may be further worsened because bicarbonate is removed during dialysis (11)(12)(13)(14). Using bicarbonate-containing dialysate in such a patient will add bicarbonate to the blood and also remove lactate (12)(13)(14).…”