Effect of a bicarbonate-buffered peritoneal dialysis solution on clinical and laboratory indices of dialysis
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Background: Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve the dialysis adequacy and patient outcomes in end-stage renal disease. However, being buffered with lactate, these fluids may insufficiently correct metabolic acidosis and lead to changes in peritoneal structure. Bicarbonate buffered fluids might mitigate these complications. The aim of the study was to evaluate the influence of a bicarbonate dialysis fluid on clinical and laboratory indices of dialysis adequacy. Methods: Twenty PD patients treated with standard lactate solutions, were divided into two groups. Patients in the study group started treatment with a 34 mmol/L bicarbonate-buffered solution, whereas those in the control group continued on a lactate-buffered fluid. Assessment of urine output, dialysis ultrafiltration, hydration status as well as metabolic acidosis, dialysis adequacy and potential inflow pain was performed at baseline and at six weeks intervals for 24 weeks. Results: In the studied group, pH was 7.36 ± 0.03, HCO3 22.1 ± 1.8 mmol/l at baseline and 7.36 ± 0.04, and 21.2 ± 2.3 mmol/l at the end of the study, while in the control group the pH was 7.35 ± 0.12, with HCO3 22.2 ± 1.4 mmol/l, and 7.40 ± 0.03, and 22.3 ± 1.8 mmol/l, respectively. No statistically significant differences were noted. Dialysis effectiveness, measured as urea Kt/V, urine output and dialysis ultrafiltration did not differ between the groups, either at baseline or at the study termination. Only one patient in the studied group reported inflow pain and following conversion to bicarbonate-buffered PD fluid he reported reduction of its intensity. Conclusion: Bicarbonate-buffered PD solution appears to be similar to standard fluid in terms of the impact on residual renal function and ultrafiltration as well as on acid-base balance and infusion pain. Longitudinal studies are needed to assess the long-term advantages of this biocompatible solution in PD patients.
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