title: Effect of the dialysis fluid buffer on peritoneal membrane function in children.
abstract: OBJECTIVE
  Double-chamber peritoneal dialysis fluids exert less toxicity by their neutral pH and reduced glucose degradation product content. The role of the buffer compound (lactate and bicarbonate) has not been defined in humans.
  
  
  METHODS
  A multicenter randomized controlled trial in 37 children on automated peritoneal dialysis was performed. After a 2-month run-in period with conventional peritoneal dialysis fluids, patients were randomized to neutral-pH, low-glucose degradation product peritoneal dialysis fluids with 35 mM lactate or 34 mM bicarbonate content. Clinical and biochemical monitoring was performed monthly, and peritoneal equilibration tests and 24-hour clearance studies were performed at 0, 3, 6, and 10 months.
  
  
  RESULTS
  No statistically significant difference in capillary blood pH, serum bicarbonate, or oral buffer supplementation emerged during the study. At baseline, peritoneal solute equilibration and clearance rates were similar. During the study, 4-hour dialysis to plasma ratio of creatinine tended to increase, and 24-hour dialytic creatinine and phosphate clearance increased with lactate peritoneal dialysis fluid but not with bicarbonate peritoneal dialysis fluid. Daily net ultrafiltration, which was similar at baseline (lactate fluid=5.4±2.6 ml/g glucose exposure, bicarbonate fluid=4.9±1.9 ml/g glucose exposure), decreased to 4.6±1.0 ml/g glucose exposure in the lactate peritoneal dialysis fluid group, whereas it increased to 5.1±1.7 ml/g glucose exposure in the bicarbonate content peritoneal dialysis fluid group (P=0.006 for interaction).
  
  
  CONCLUSIONS
  When using biocompatible peritoneal dialysis fluids, equally good acidosis control is achieved with lactate and bicarbonate buffers. Improved long-term preservation of peritoneal membrane function may, however, be achieved with bicarbonate-based peritoneal dialysis fluids.
authors.affiliation: University Children's Hospital, Heidelberg, Germany. claus.peter.schmitt@med.uni-heidelberg.de
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.forename: Barbara
authors.initials: B
authors.lastname: Nau
authors.forename: Gita
authors.initials: G
authors.lastname: Gemulla
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Bonzel
authors.forename: Tuula
authors.initials: T
authors.lastname: Hölttä
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Anja
authors.initials: A
authors.lastname: Sander
authors.forename: Klaus
authors.initials: K
authors.lastname: Arbeiter
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000378:metabolism / Q000517:prevention & control; D000293:Adolescent; D001639:Bicarbonates / Q000008:administration & dosage; D001834:Body Water / Q000378:metabolism; D002021:Buffers; D002648:Child; D002675:Child, Preschool; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D019344:Lactic Acid / Q000008:administration & dosage; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D002021:Buffers; D015314:Dialysis Solutions; D019344:Lactic Acid