A controlled trial of two bicarbonate-containing dialysis fluids for CAPD: final report

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 1998-12, Vol.13 (12), p.3165-3171
• Main Authors: COLES, G. A, O'DONOGHUE, D. J, HOPWOOD, A, FAICT, D, PRITCHARD, N, OGG, C. S, JANI, F. M, GOKAL, R, CANCARINI, G. C, MAIORCA, R, TRANAEUS, A, DE VOS, C
• Format: Article
• Language: English
• Subjects: Acid-Base Equilibrium - drug effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bicarbonates - administration & dosage; Bicarbonates - adverse effects; Biological and medical sciences; Biological Transport - drug effects; Dialysis Solutions - adverse effects; Dialysis Solutions - therapeutic use; Drug Combinations; Emergency and intensive care: renal failure. Dialysis management; Evaluation Studies as Topic; Female; Humans; Intensive care medicine; Kidney - drug effects; Kidney - physiopathology; Lactic Acid - administration & dosage; Lactic Acid - adverse effects; Male; Medical sciences; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum - metabolism; Prospective Studies
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/13.12.3165

The combination of a low pH and a high concentration of lactate which is present in most dialysis fluids is found to be cytotoxic in vitro. For these reasons it would seem logical to use a bicarbonate-containing solution and thus automatically provide a solution with a neutral pH. A parallel, randomized, open-label, prospective 2-month trial with an optional 4 month extension was undertaken to compare two novel bicarbonate-based solutions; one containing 38 mmol/l of bicarbonate (B), and one containing a mixture of 25 mmol/l bicarbonate and 15 mmol/l of lactate (B/L), with a control solution (C) containing 40 mmol/l lactate. Three groups of 19 (C), 20 (B), and 20 (B/L) patients were recruited and data from approximately 55 patient months were accumulated in each group. The data show that both bicarbonate-based solutions maintain acid-base levels within the normal range, that there were no changes in any of the other blood biochemistry parameters measured in the peritoneal equilibration test or with regard to adequacy of dialysis, and that furthermore, both solutions were well tolerated. This study showed that either the bicarbonate or bicarbonate/lactate solutions could be utilized efficaciously in patients undergoing CAPD.