Use of bicarbonate/lactate-buffered dialysate with a nighttime cycler, associated with a daytime dwell with icodextrin, may result in alkalosis in children.
The aim of peritoneal dialysis (PD) remains to deliver "appropriate" renal replacement therapy, including sufficient ultrafiltration, correction of acid-base balance, and adequate dialysis dose. We switched our pediatric patients on automated PD from standard lactate-buffered glucose solution (Dianeal: Baxter Healthcare SA, Castlebar, Ireland) to bicarbonate/lactate-buffered solution (Physioneal: Baxter Healthcare SA) as soon as it became available in our country. We also decided to deliver "optimal" dialysis in children by prescribing a long daytime dwell with icodextrin solution (Extraneal: Baxter Healthcare SA). But, adding those three benefits together--APD, Physioneal, and a long dwell with icodextrin--the result, at least in children, was a possible overcorrection of acidosis and an evolution to alkalosis. Thought must be given to developing solutions with varying bicarbonate concentrations for various treatment modalities.
Vande Walle
Johan G J
JG
Pediatric Nephrology, University Hospital, Gent, Belgium. Johan.VandeWalle@Ugent.be
Raes
Ann M
AM
Dehoorne
Joke
J
Mauel
Reiner
R
D000471:Alkalosis / Q000209:etiology*; D001639:Bicarbonates; D002648:Child; D002675:Child, Preschool; D005260:Female; D005936:Glucans; D005947:Glucose; D015312:Hemodialysis Solutions / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D000077607:Icodextrin; D007223:Infant; D019344:Lactic Acid; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*
D001639:Bicarbonates; D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D019344:Lactic Acid; D005947:Glucose