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 product (GDP) solutions potentially being more biocompatible.
• The comparative benefits of bicarbonate versus lactate solutions for acute PD remain unclear.

Purpose of the Study:

• To evaluate the benefits and harms of using bicarbonate solutions compared to lactate solutions in acute peritoneal dialysis (PD).

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included major databases like CENTRAL, MEDLINE, EMBASE, and LILACS up to May 2014.
• Data were independently extracted and analyzed using random-effects models, with results reported as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CI).

Main Results:

• One RCT with 20 patients was included.
• In shock patients, bicarbonate showed no mortality difference but improved blood lactate, serum bicarbonate, and blood pH compared to lactate.
• In non-shock patients, bicarbonate improved blood lactate but not serum bicarbonate or blood pH compared to lactate.

Conclusions:

• Current evidence does not strongly support a clinical advantage of using bicarbonate over lactate solutions for acute PD in AKI patients.
• Limited data prevent comprehensive analysis of other outcomes.
• Further research is necessary to clarify the role of different PD solutions.