Advantages of HCO3 solution with low sodium concentration over standard lactate solutions for acute peritoneal dialysis.
The aim of this study was to identify the advantages of a bicarbonate solution with a low sodium concentration. Twelve children (3 days-6 years) with acute renal failure (ARF), positive fluid balance, and lactate acidosis (> 40 mg/dL) were treated by automated peritoneal dialysis (APD) with frequent exchanges of small fill volumes of a hypertonic solution. For Day 1 we used PD1/PD4 Dianeal (3.86%) (Baxter). After 24 hours we switched to a HCO3 solution: 38 mmol/L, Na 128 mmol/L. As the control group, we studied retrospectively the last 12 children of the previous period who were treated with APD. The age distribution was 4 days to 4 years. No significant differences were found between the groups for serum creatinine, blood urea nitrogen, and fluid overload (Day 1 to Day 4). Although the values for lactate and Na were not different before the start of the study (Day 1) and after 24 hours of Dianeal (Day 2), they were significantly lower in the study group on Day 4 [HCO3 53 (23-83), Na 148 (137-136) mEq/L] than in the control group [lactate 148 (137-156), Na 154 (142-165) mEq/L]. A low sodium concentration results in higher sodium extraction, which is important for patients with fluid overload. Low sodium concentrations in APD are needed because the peritoneal membrane "sieves" the sodium during short dwells. HCO3 dialysis is a logical choice for patients with lactate acidosis, resulting in a significant lower serum lactate and increase of BE after 48 hours of treatment.
Vande Walle
J
J
University Hospital, Gent, Belgium.
Raes
A
A
Castillo
D
D
Lutz-Dettinger
N
N
Dejaegher
A
A
D058186:Acute Kidney Injury / Q000628:therapy*; D001639:Bicarbonates; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood
D001639:Bicarbonates; D015314:Dialysis Solutions; D019344:Lactic Acid; D012964:Sodium; D003404:Creatinine