title: L-lactate for high-efficiency hemodialysis: feasibility studies and a randomized comparison with acetate and bicarbonate.
abstract: 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.
authors.affiliation: Department of Medicine, Veterans Administration Hospital, Hines, IL.
authors.forename: S P
authors.initials: SP
authors.lastname: Dalal
authors.forename: M
authors.initials: M
authors.lastname: Ajam
authors.forename: D K
authors.initials: DK
authors.lastname: Gupta
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: Z
authors.initials: Z
authors.lastname: Nawab
authors.forename: F J
authors.initials: FJ
authors.lastname: Manahan
authors.forename: T S
authors.initials: TS
authors.lastname: Ing
authors.forename: J T
authors.initials: JT
authors.lastname: Daugirdas
mesh_terms: D000085:Acetates; D000136:Acid-Base Equilibrium; D001639:Bicarbonates; D015314:Dialysis Solutions; D004311:Double-Blind Method; D005240:Feasibility Studies; D015312:Hemodialysis Solutions; D006801:Humans; D007773:Lactates; D019344:Lactic Acid; D008297:Male; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis
chemical_list: D000085:Acetates; D001639:Bicarbonates; D015314:Dialysis Solutions; D015312:Hemodialysis Solutions; D007773:Lactates; D019344:Lactic Acid