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Related Experiment Videos

Acid-base balance on peritoneal dialysis

G La Greca, S Biasioli, S Chiaramonte

    Clinical Nephrology
    |July 1, 1981
    PubMed
    Summary

    This study compares acetate and lactate buffers in peritoneal dialysis (PD). Lactate is safer than acetate for continuous ambulatory peritoneal dialysis (CAPD) due to better acid-base balance control.

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    Area of Science:

    • Nephrology
    • Biochemistry
    • Clinical Medicine

    Background:

    • Acid-base balance is crucial in peritoneal dialysis (PD).
    • Acetate and lactate buffers are commonly used in PD fluids.
    • Understanding buffer kinetics is essential for optimizing PD therapy.

    Purpose of the Study:

    • To compare the acid-base balance and buffer kinetics of acetate and lactate during intermittent (IPD) and continuous ambulatory peritoneal dialysis (CAPD).
    • To evaluate the safety and efficacy of acetate versus lactate buffers in different PD modalities.

    Main Methods:

    • Forty studies were conducted on 20 patients undergoing IPD and CAPD with either acetate or lactate buffer.
    • Blood and dialysate samples were analyzed for acetate, lactate, and pyruvate levels.

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  • Blood gas analysis and kinetic calculations were performed to quantify buffer utilization and bicarbonate generation.

    • Main Results:

    • On IPD, acetate and lactate showed similar kinetics, with acetate having a higher conversion rate to bicarbonate (71%) than lactate (45%).
    • On CAPD, lactate levels remained low, while acetate levels were significantly higher.
    • CAPD with lactate maintained stable serum bicarbonate levels, whereas acetate led to a trend of exceeding physiological values.

    Conclusions:

    • Buffer utilization differs significantly between IPD and CAPD.
    • Lactate appears to be a safer buffer than acetate for CAPD, ensuring better acid-base homeostasis.
    • Acetate concentration in CAPD dialysate should be limited to below 38.5 mM/l.