Clinical experience with a new bicarbonate (25 mmol/L)/lactate (10 mmol/L) peritoneal dialysis solution.
OBJECTIVE
Physiological bicarbonate/lactate-based solutions may correct acidosis in a better way than standard lactate-based solutions. In this study, a new 25 mmol/L bicarbonate/10 mmol/L lactate peritoneal dialysis (PD) solution was compared with a standard 35 mmolL lactate solution.


METHODS
This was a prospective open label study. All patients had a 2-week baseline period using the standard lactate solution, followed by 8 weeks on the bicarbonate/ lactate solution and 2 weeks on the lactate-based solution.


METHODS
Four Danish and four Spanish nephrology centers.


METHODS
40 well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) patients on continuous ambulatory PD.


METHODS
Blood samples were taken for biochemistry (including venous blood gases) at week -2, day 1, weeks 2, 4, and 8, and at follow-up. A physical examination, a peritoneal equilibration test (PET), and quality of life (K/DQOL), ultrafiltration, and adequacy assessments were performed at baseline and at week 8. Vital signs and other safety parameters were followed at each visit. Extraneal (Baxter Healthcare, Castlebar, Ireland) was used by all patients for the long dwell.


METHODS
Effect on the venous plasma bicarbonate level.


RESULTS
Venous plasma bicarbonate levels rose from 24.4 mmol/L when patients were on the pure lactate to 26.1 mmol/L when using the bicarbonate/lactate solution (p < 0.001). When patients were using the bicarbonate/ lactate solution, 66% of values were maintained within the venous normal range of 24-30 mmol/L, versus 46.2% when patients were on the pure lactate solution (p < 0.001). There were no adverse findings with respect to clinical symptoms, vital signs, or physical examination. The PET and adequacy, ultrafiltration, and K/DQOL assessment results were unchanged.


CONCLUSIONS
The new 25 mmol/L bicarbonate/ 10 mmol/L lactate solution provided better correction of acidosis than an equivalent 35 mmol/L standard lactate solution, without any safety issues.
Otte
Kjeld
K
Fredericia Sygehus Medicinsk afd, Fredericia, Denmark kot@fs.vejleamt.dk
Gonzalez
Maria Theresa
MT
Bajo
Maria-Auxiliadora
MA
del Peso
Gloria
G
Heaf
James
J
Garcia Erauzkin
Gorka
G
Sanchez Tomero
Jose A
JA
Dieperink
Hans
H
Povlsen
Johan
J
Hopwood
Alexandra M
AM
Divino Filho
Jose C
JC
Faict
Dirk
D
D000138:Acidosis / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D002021:Buffers; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy*; D019344:Lactic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D011446:Prospective Studies; D013997:Time Factors
D001639:Bicarbonates; D002021:Buffers; D015314:Dialysis Solutions; D004338:Drug Combinations; D019344:Lactic Acid