title: Effects of a new bicarbonate/lactate-buffered neutral peritoneal dialysis fluid for peritoneal failure in patients undergoing peritoneal dialysis.
abstract: BACKGROUND
  The highly concentrated lactate in peritoneal dialysis fluid (PDF) has been considered to contribute to peritoneal failure in patients undergoing PD. A new PDF containing a lower lactate concentration, physiological bicarbonate concentration, and neutral pH (bicarbonate/lactate-buffered neutral PDF) was recently developed. We compared the clinical effects of this bicarbonate/lactate-buffered neutral PDF and a lactate-buffered neutral PDF.
  
  
  METHODS
  Patients undergoing PD were changed from a lactate-buffered neutral PDF to a bicarbonate/lactate-buffered neutral PDF. We then investigated the changes in peritoneal functions as estimated by a peritoneal equilibration test (PET) and the following surrogate markers of peritoneal membrane failure in the drained dialysate: fibrin degradation products (FDP), vascular endothelial growth factor (VEGF), cancer antigen 125 (CA125), interleukin-6 (IL-6), and transforming growth factor beta 1 (TGF-β1).
  
  
  RESULTS
  Fourteen patients undergoing PD were enrolled. The PET results were not different before and after use of the bicarbonate/lactate-buffered neutral PDF. The FDP concentration significantly decreased from 15.60 ± 13.90 to 6.04 ± 3.49 μg/mL (p = 0.02) and the VEGF concentration significantly decreased from 37.83 ± 15.82 to 27.70 ± 3.80 pg/mL (p = 0.02), while the CA125 and IL-6 concentrations remained unchanged before and after use of the bicarbonate/lactate-buffered neutral PDF. TGF-β1 was not detected in most patients.
  
  
  CONCLUSIONS
  The bicarbonate/lactate-buffered neutral PDF decreased the FDP and VEGF concentrations in the drained dialysate. These results suggest that the decreased lactate level achieved by administration of bicarbonate with a neutral pH in PDF may contribute to decreased peritoneal membrane failure in patients undergoing PD.
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Kitano
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Shindo
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Miyazawa
authors.affiliation: Division of Endocrinology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Ito
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kaku
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Honami
authors.initials: H
authors.lastname: Mori
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ookawara
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tabei
authors.affiliation: Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D001639:Bicarbonates / Q000494:pharmacology*; D015415:Biomarkers / Q000378:metabolism; D002021:Buffers; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000494:pharmacology*; D008297:Male; D008566:Membranes / Q000187:drug effects; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D002021:Buffers; D015314:Dialysis Solutions; D019344:Lactic Acid