Twenty years of bicarbonate solutions

Peritoneal dialysis solutions have long used lactate as a buffer. Lactate's role in correcting uremic acidosis remains debated. Concerns exist about its impact on peritoneal cells. High lactate flux during CAPD may cause metabolic issues. These risks led to a search for alternatives. Bicarbonate emerged as a possible replacement. Solubility issues with calcium and magnesium carbonate were addressed. A two-compartment bag system enabled bicarbonate mixing. This innovation allowed for safer use in dialysis.

The study aimed to evaluate bicarbonate-buffered solutions in peritoneal dialysis. It focused on long-term safety and efficacy. The goal was to compare bicarbonate with lactate-based solutions. Researchers wanted to assess acid-base correction. They also examined effects on residual renal function. Inflammation and peritonitis rates were key outcomes. The study sought to confirm biocompatibility improvements. It aimed to support bicarbonate as a preferred buffer.

Researchers used a two-compartment bag system. This allowed bicarbonate and cations to mix before infusion. Randomized controlled trials assessed acid-base balance. Observational studies tracked clinical outcomes. Data included residual renal function and inflammation. Peritonitis incidence was monitored over time. Biocompatibility was evaluated using cell studies. Long-term safety was analyzed over 15 years.

RCTs showed improved acid-base correction with bicarbonate. Observational data revealed preserved renal function. Inflammation levels were lower in bicarbonate groups. Peritonitis rates decreased with this solution. Local biocompatibility improved significantly. Bicarbonate showed better metabolic safety. No major adverse effects were reported. These findings support its clinical use.

Bicarbonate is a physiological buffer and safer than lactate. It improves acid-base balance and renal function. It reduces inflammation and peritonitis risk. Long-term use is well-tolerated and effective. Biocompatibility is better with bicarbonate. These benefits align with its natural role in the body. The evidence supports its use in PD. It should be considered the preferred buffer option.