HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Schmitt CP, Gemulla G, Bonzel KE, et al.

BIOKID: Randomized Controlled Trial Comparing Bicarbonate and Lactate Buffer in Biocompatible Peritoneal Dialysis Solutions in Children.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:696A 2007

Double-chamber peritoneal dialysis fluids (PDFs) exert less local and systemic toxicity by their neutral pH and greatly reduced glucose degradation product (GDP) content. We previously demonstrated superior acidosis correction with bicarbonate-based biocompatible vs. lactate-buffered conventional PDF. Preliminary experimental comparisons of biocompatible PDFs suggest specific buffer-related differences regarding mesenteric perfusion and aquaporin expression in the peritoneal membrane.

In order to elucidate whether the buffer choice is of clinical relevance when using biocompatible PDFs. we performed a multi-center randomized controlled trial in 37 pediatric patients on automated PD. After a 2 months baseline period with conventional high-GDP PDF (CAPD, Fresenius), patients were randomized to neutral-pH, low-GDP PDFs which either contained 35 mM lactate (Balance Fresenius, LPDF) or 34 mM bicarbonate (BicaVera, BPDF). Clinical and biochemical follow up was performed monthly, and peritoneal equilibration tests at 0, 3, 6 and 10 months.

Peritoneal equilibration rates, small solute and albumin clearances were similar in both groups at baseline and remained unchanged after 3, 6 and 10 months. No difference in blood pH or serum bicarbonate and oral buffer supply emerged during the study. Daily net ultrafiltration was 5.6 2.6 and 4.9 1.9 ml per gram glucose exposure at baseline in patients randomized for LPDF and BPDF respectively (n.s.). After 10 months ultrafiltration had decreased to 4.2 1.2 with LPDF and increased to 5.2 1.7 ml/g glucose with BPDF (p=0.06 for slopes) at similar overall glucose exposure.

We conclude that when using biocompatible PDF, equally good acidosis control is achieved with lactate and biocarbonate buffer systems. While no differences in solute transport were apparent within 10 treatment months, ultrafiltration capacity tended to increase with bicarbonate based PDF.

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