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Related Experiment Videos

Randomized long-term evaluation of bicarbonate-buffered CAPD solution

M Feriani1, J Kirchgessner, G La Greca

  • 1Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy and Fresenius AG Medical Science Department, Oberursel, Germany. mferani@goldne.it

Kidney International
|December 9, 1998
PubMed
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See all related articles

Bicarbonate-buffered peritoneal dialysis solutions effectively correct metabolic acidosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This study found bicarbonate solutions to be safe and efficacious, potentially replacing traditional lactate-buffered solutions.

Area of Science:

  • Nephrology
  • Internal Medicine
  • Biochemistry

Background:

  • Lactate has been a standard buffer in peritoneal dialysis (PD) solutions for 15 years, but concerns exist regarding its effectiveness in correcting uremic acidosis and biocompatibility.
  • Potential adverse metabolic effects from high lactate flux during continuous ambulatory peritoneal dialysis (CAPD) have driven the search for alternative buffers.
  • Bicarbonate, a physiological buffer, was explored, with a two-compartment system resolving solubility issues with calcium and magnesium.

Purpose of the Study:

  • To evaluate the long-term tolerance, safety, efficacy, and therapeutic value of bicarbonate-buffered peritoneal dialysis solutions.
  • To compare bicarbonate-buffered solutions with conventional lactate-buffered solutions in CAPD patients.

Main Methods:

Related Experiment Videos

  • An open, randomized, controlled, multicenter study was conducted over two consecutive 12-week treatment phases.
  • Fourteen centers participated, comparing a 34 mmol/liter bicarbonate-buffered solution with a 35 mmol/liter lactate-buffered solution.
  • Patient outcomes and acid-base status were monitored over a six-month study period.

    • Main Results:

    • Patients in the bicarbonate group with metabolic acidosis showed significant improvement in blood pH and plasma bicarbonate levels.
    • No significant acid-base changes were observed in acidotic patients treated with lactate-buffered solutions.
    • While normalized protein catabolic rate (nPCR) decreased in the lactate group, it increased in the bicarbonate group, with significant differences between groups at 24 weeks.
    • No significant differences were found in other biochemical profiles, peritoneal function, or dialysate protein loss between the groups.
    • No adverse effects related to the study solutions were reported.

    Conclusions:

    • Bicarbonate-buffered peritoneal dialysis solutions demonstrated efficacy and safety in a six-month randomized controlled trial.
    • These findings support the potential of bicarbonate-buffered solutions to replace conventional lactate-buffered CAPD solutions.
    • Bicarbonate represents a physiologically superior buffering agent for peritoneal dialysis therapies.