Long-term clinical experience with pure bicarbonate peritoneal dialysis solutions

The aim of this prospective study was to collect long-term experience in incident peritoneal dialysis (PD) patients treated with pure bicarbonate-buffered PD fluids. The metabolic parameters acidosis, acid-base status, adequacy, fluid balance, nutritional markers, calcium, phosphorus, parathyroid ho...

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Bibliographic Details
Published in:	Peritoneal dialysis international Vol. 26; no. 1; pp. 89 - 94
Main Authors:	MONTENEGRO, Jesus, SARACHO, Ramon M, MARTINEZ, Isabel M, MUNOZ, Rosa I, OCHARAN, Julian J, VALLADARES, Evandro
Format:	Journal Article
Language:	English
Published:	Milton, ON Multimed 2006
Subjects:	Acidosis - blood Acidosis - chemically induced Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Bicarbonates - analysis Bicarbonates - blood Biological and medical sciences Dialysis Solutions - adverse effects Dialysis Solutions - chemistry Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Glomerulonephritis Humans Intensive care medicine Kidney Failure, Chronic - therapy Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Peritoneal Dialysis, Continuous Ambulatory - adverse effects Prognosis Prospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Time Factors Kidney disease Urinary system disease Renal function residual renal function Hemodialysis Peritoneal dialysis Hydrogencarbonates Extrarenal dialysis Ultrafiltration Renal failure bicarbonate Acid-base status dialysis adequacy
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Summary:	The aim of this prospective study was to collect long-term experience in incident peritoneal dialysis (PD) patients treated with pure bicarbonate-buffered PD fluids. The metabolic parameters acidosis, acid-base status, adequacy, fluid balance, nutritional markers, calcium, phosphorus, parathyroid hormone (PTH), and general laboratory work and medication were compared between incident PD patients in two groups: one treated with a 34 mmol/L bicarbonate-buffered PD fluid (BIC), the other with a 35 mmol/L lactate-buffered PD fluid (LAC). The observation period included 5 visits from 1 month (visit 1) until 12 months (visit 5) after the start of dialysis treatment. For the descriptive analysis, means and standard deviations were calculated. Student's t-test and linear mixed models were used to compare the two treatment groups. 36 patients were followed for 12 months, 18 in the BIC group and 18 in the LAC group. Statistically significant differences between the groups (at the end of study) were found. In BIC group, venous plasma bicarbonate was 27.4 +/- 2.3 mmol/L, base excess 0.8 +/- 2.2 mmol/L, and pH 7.31 +/- 0.05; in LAC group, venous bicarbonate was 25.9 +/- 2.4 mmol/L, base excess -0.6 +/- 2.1 mmol/L, and pH 7.30 +/- 0.04. No patient from the BIC group needed oral bicarbonate, in contrast to 4 patients in the LAC group. Whereas peritoneal urea and creatinine clearances did not differ between the groups, there was better renal solute clearance in the BIC group, accompanied by better-preserved diuresis at 12 months (1333 +/- 935 mL with BIC vs 839 +/- 556 mL with LAC). The reverse was true for ultrafiltration. Pure bicarbonate-buffered PD solutions were superior in correcting metabolic acidosis and they allowed omission of oral bicarbonate. The minor ultrafiltration with bicarbonate-buffered PD solutions was counterbalanced by better-preserved residual renal function with these solutions.
ISSN:	0896-8608 1718-4304
DOI:	10.1177/089686080602600114