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Advantages of HCO3 solution with low sodium concentration over standard lactate solutions for acute peritoneal
J Vande Walle1, A Raes, D Castillo
1University Hospital, Gent, Belgium.
Insights
This study shows that bicarbonate dialysis with low sodium concentration effectively reduces lactate and improves acid-base balance in children with acute renal failure. Low sodium extraction is crucial for managing fluid overload during peritoneal dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Acid-Base Balance
Background:
- Acute renal failure (ARF) in children often presents with fluid overload and lactate acidosis.
- Automated peritoneal dialysis (APD) is a treatment option for pediatric ARF.
- Optimizing dialysis solutions is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a bicarbonate solution with low sodium concentration in pediatric APD.
- To assess the impact on lactate levels, acid-base balance, and fluid status.
- To determine the advantages of low sodium concentration in APD for fluid overload.
Main Methods:
- Retrospective study comparing children treated with a bicarbonate solution versus a control group.
- All patients underwent automated peritoneal dialysis (APD) with frequent exchanges.
- Study involved pediatric patients aged 3 days to 6 years with ARF, fluid overload, and lactate acidosis.
Main Results:
- No significant differences in serum creatinine, blood urea nitrogen, or fluid overload between groups.
- Significantly lower lactate and higher bicarbonate levels observed in the study group by Day 4.
- Low sodium concentration in APD led to increased sodium extraction, beneficial for fluid overload.
Conclusions:
- Bicarbonate dialysis is effective in managing lactate acidosis in pediatric ARF.
- Low sodium concentration in APD enhances sodium removal, crucial for fluid management.
- APD with low sodium bicarbonate solutions offers advantages for children with ARF and fluid overload.
Abstract:
The aim of this study was to identify the advantages of a bicarbonate solution with a low sodium concentration. Twelve children (3 days-6 years) with acute renal failure (ARF), positive fluid balance, and lactate acidosis (> 40 mg/dL) were treated by automated peritoneal dialysis (APD) with frequent exchanges of small fill volumes of a hypertonic solution. For Day 1 we used PD1/PD4 Dianeal (3.86%) (Baxter). After 24 hours we switched to a HCO3 solution: 38 mmol/L, Na 128 mmol/L. As the control group, we studied retrospectively the last 12 children of the previous period who were treated with APD. The age distribution was 4 days to 4 years. No significant differences were found between the groups for serum creatinine, blood urea nitrogen, and fluid overload (Day 1 to Day 4). Although the values for lactate and Na were not different before the start of the study (Day 1) and after 24 hours of Dianeal (Day 2), they were significantly lower in the study group on Day 4 [HCO3 53 (23-83), Na 148 (137-136) mEq/L] than in the control group [lactate 148 (137-156), Na 154 (142-165) mEq/L]. A low sodium concentration results in higher sodium extraction, which is important for patients with fluid overload. Low sodium concentrations in APD are needed because the peritoneal membrane "sieves" the sodium during short dwells. HCO3 dialysis is a logical choice for patients with lactate acidosis, resulting in a significant lower serum lactate and increase of BE after 48 hours of treatment.