Bicarbonate versus lactate solutions for acute peritoneal dialysis

Area of Science:

• Nephrology
• Intensive Care Medicine
• Renal Replacement Therapy

Background:

• Acute kidney injury (AKI) in critically ill patients has high mortality, despite renal replacement therapy (RRT).
• Newer peritoneal dialysis (PD) fluids may preserve peritoneal function, with low glucose degradation products (GDPs) in "biocompatible" solutions.
• The comparative efficacy of conventional lactate versus low GDP bicarbonate solutions for acute PD remains unclear.

Purpose of the Study:

• To evaluate the benefits and harms of bicarbonate versus lactate solutions in acute PD for AKI patients.
• To compare the clinical outcomes of different PD fluid compositions in intensive care settings.

Main Methods:

• Systematic search of multiple databases including CENTRAL, MEDLINE, EMBASE, and LILACS.
• Inclusion of randomized controlled trials (RCTs) comparing bicarbonate and lactate solutions for acute PD.
• Data extraction and quality assessment by two independent reviewers, with random-effects model analysis for results.

Main Results:

• One RCT with 20 patients was included. In shock patients, no mortality difference was observed between bicarbonate and lactate solutions.
• Bicarbonate solutions showed significant differences in blood lactate, serum bicarbonate, and blood pH in shock patients.
• In non-shock patients, bicarbonate solutions significantly reduced blood lactate but not serum bicarbonate or blood pH compared to lactate solutions.

Conclusions:

• Limited evidence suggests no clear clinical advantage of bicarbonate over lactate solutions for acute PD in AKI.
• Further high-quality research is necessary to establish the optimal PD fluid composition for critically ill patients.
• Current evidence does not strongly support the use of low GDP bicarbonate solutions over conventional lactate solutions for acute PD in AKI.