Effect of the dialysis fluid buffer on peritoneal membrane function in children

Area of Science:

• Nephrology
• Pediatric Nephrology
• Renal Replacement Therapy

Background:

• Double-chamber peritoneal dialysis (PD) fluids offer reduced toxicity due to neutral pH and lower glucose degradation products.
• The comparative efficacy of lactate versus bicarbonate buffers in these advanced PD fluids remains undefined in pediatric populations.

Purpose of the Study:

• To compare the effects of lactate-based versus bicarbonate-based biocompatible PD fluids on acidosis control and peritoneal membrane function in children undergoing automated PD.

Main Methods:

• A multicenter randomized controlled trial involving 37 children on automated PD.
• Patients received either lactate- or bicarbonate-containing neutral-pH, low-GDP PD fluids after an initial run-in period.
• Clinical, biochemical, peritoneal equilibration, and clearance parameters were monitored over 10 months.

Main Results:

• Both fluid types achieved comparable acidosis control, with no significant differences in blood pH or serum bicarbonate levels.
• Creatinine and phosphate clearance showed a trend toward increase with lactate fluid, but not bicarbonate fluid.
• Net ultrafiltration decreased with lactate fluid but increased with bicarbonate fluid, indicating a potential difference in peritoneal membrane response (P=0.006).

Conclusions:

• Lactate and bicarbonate buffers in biocompatible PD fluids provide equivalent acidosis management in pediatric patients.
• Bicarbonate-based PD fluids may offer superior long-term preservation of peritoneal membrane function compared to lactate-based fluids.