Bicarbonate solutions: update

The use of lactate-based peritoneal dialysis solutions (PDFs) requires hepatic metabolism to convert lactate to bicarbonate. Pure bicarbonate solutions are particularly useful in the setting of hepatic dysfunction and whenever a high risk of lactate accumulation in the blood exists. This article reviews the recent literature related to laboratory findings and clinical experiences with bicarbonate-containing PDFs. The data suggest that bicarbonate-based solutions are safe and well tolerated and that, among patients with severe metabolic acidosis, they provide better correction of that acidosis than do lactate-containing PDFs. In addition, use of bicarbonate solution seems to be associated with improved nutrition, better growth rate in children with end-stage renal disease, better preservation of residual renal function, and, possibly, higher peritoneal ultrafiltration and a lower peritonitis rate. More experience with these solutions and more prospective controlled studies should be encouraged to further characterize the potential benefits of bicarbonate solutions.