Bicarbonate versus lactate solutions for acute peritoneal dialysis.
BACKGROUND
The high mortality rate among critically ill patients with acute kidney injury (AKI) remains an unsolved problem in intensive care medicine, despite the use of renal replacement therapy (RRT). Increasing evidence from clinical studies in adults and children suggests that the new peritoneal dialysis (PD) fluids may allow for better long-term preservation of peritoneal morphology and function. Formation of glucose degradation products (GDPs) can be reduced and even avoided with the use of newer "biocompatible" solutions. However, it is still unclear if there are any differences in using conventional (lactate) solutions compared with low GDP (bicarbonate) solutions for acute PD.


OBJECTIVE
To look at the benefits and harms of bicarbonate versus lactate solutions in acute PD.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1966), EMBASE (from 1980), Latin American and Caribbean Health Sciences Literature Database LILACS (from 1982), and reference lists of articles.


METHODS
Randomised controlled trials (RCTs) comparing bicarbonate to lactate solution for acute PD.


METHODS
Two authors independently assess the methodological quality of studies. One author abstracted data onto a standard form, and a second author checked data extraction. We used the random-effects model and expressed the results as relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).


RESULTS
We included one study (20 patients) in this review. In shock patients, bicarbonate did not differ from lactate with respect to mortality (RR 0.50, 95% CI 0.06 to 3.91); however there were significant differences in blood lactate (MD -1.60 mmol/L, 95% CI -2.04 to -1.16), serum bicarbonate (MD 5.00 mmol/L, 95% CI 3.26 to 6.74) and blood pH (MD 0.12, 95% CI 0.06 to 0.18). In non-shock patients there was a significance difference in blood lactate (MD -0.60 mmol/L, 95% CI -0.85 to -0.35) but not in serum bicarbonate (MD 1.10 mmol/L, 95% CI -0.27 to 2.47) or blood pH (MD -0.02, 95% CI -0.02 to -0.06). Other outcomes could not be analysed because of the limited data available.


CONCLUSIONS
There is no strong evidence that any clinical advantage for patients requiring acute PD for AKI when comparing conventional (lactate) with low GDP dialysis solutions (bicarbonate).
Bai
Zheng Gang
ZG
a) Integrated Traditional Chinese and Western Medicine Research Institution, School of Basic Medicine Sciences of Lanzhou University, Lanzhou City, China, b) Evidence-based Medicine Centre of Lanzhou University, Lanzhou City, China c) Social Work School, University of Southern California, Los Angeles, USA.
Yang
Kehu
K
Tian
Jinhui
J
Ma
Bin
B
Liu
Yali
Y
Jiang
Lei
L
Tan
Jiying
J
Liu
Tian Xi
TX
Chi
Iris
I
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000328:Adult; D001639:Bicarbonates / Q000009:adverse effects / Q000627:therapeutic use*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D019344:Lactic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D010530:Peritoneal Dialysis / Q000379:methods* / Q000401:mortality
D001639:Bicarbonates; D015314:Dialysis Solutions; D019344:Lactic Acid