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ORIGINAL ARTICLES |
Peritoneal Dialysis Program,1 University Health Network, and University of Toronto, Toronto, Ontario, Canada; Renal Division,2 Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Renal Division,3 Baxter Healthcare Corporation, McGaw Park, Illinois, USA
Correspondence to: D.G. Oreopoulos, University Health Network, Toronto, and University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. dgo{at}teleglobal.ca
Objective: It has been proposed that biocompatible
bicarbonate/lactate based (Bic/Lac), physiologic-pH peritoneal dialysis (PD)
solutions will be beneficial in long-term PD. However, we do not yet have
detailed knowledge concerning the comparative physiology of buffer transport
for these new solutions and their impact on underlying peritoneal transport of
solutes and ultrafiltration (UF). The purpose of this study was to investigate
the profile of buffer handling and peritoneal membrane transport
characteristics during a single dwell of the new Bic/Lac-based versus standard
lactate-based (Lac) PD solution. Methods: In this prospective crossover study, we
compared a 25 mmol/L bicarbonate/15 mmol/L lactate buffered, physiologic pH,
low glucose degradation product (GDP) solution (Physioneal; Baxter Healthcare,
McGaw Park, Illinois, USA) with a standard lactate buffered, acidic pH,
conventional solution (Dianeal; Baxter). 18 patients underwent two peritoneal
equilibration tests (PETs) with 2.5% Dianeal and 2.5% Physioneal separated by
1 week. Buffer transport, mass transfer area coefficients (MTACs), solute
transport, and UF were determined for the two PETs. All bags were weighed by a
nurse before instillation and after drainage to assess the net UF in each
dwell. Results: 18 patients that met the inclusion criteria
were enrolled in this study. Whereas intraperitoneal pH remained constant at
7.52 ± 0.11 throughout the dwell with the Bic/Lac solution, pH was
still in the acidic range with the Lac solution after 1 hour (7.29 ±
0.13, p < 0.001); this difference disappeared after the second
hour of dwell. The MTACs for creatinine (10.68 ± 3.66 vs 10.73 ±
2.96 mL/minute/1.73 m2, p > 0.05) and urea (27.94
± 10.50 vs 27.62 ± 6.95 mL/min/1.73 m2, p
> 0.05), for Bic/Lac versus Lac respectively, did not differ between these
two solutions; transport of glucose and other solutes was also similar.
However, after a 4-hour dwell with Bic/Lac solution, net UF was significantly
lower than that observed with Lac solution (274.2 ± 223.3 mL vs 366.1
± 217.3 mL, p = 0.026). Conclusions: Compared to standard Lac-based solution,
Bic/Lac based, pH neutral, low-GDP solution avoids intraperitoneal acidity.
Peritoneal mass transport kinetics are similar for small solutes. Net UF is
significantly lower with Bic/Lac solution; the mechanism for this is
unclear.
KEY WORDS: Acid–base balance; bicarbonate; lactate; ultrafiltration; solute transport.
Received 13 March 2007; accepted 9 August 2007.
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