Effects of pH-neutral, bicarbonate-buffered dialysis fluid on peritoneal transport kinetics in children

Kidney International
Claus Peter SchmittFranz Schaefer

Abstract

Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal dialysis (PD) fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m2, dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. While intraperitoneal pH was constant at 7.41 +/- 0.03 throughout the SPA with bicarbonate fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 +/- 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral fluid. Ne...Continue Reading

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Citations

May 16, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Thorsten O BenderAchim Jörres
Jun 4, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Enrico VerrinaFrancesco Perfumo
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Feb 1, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Cengiz CandanNil Arisoy
Mar 31, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Claus Peter SchmittUNKNOWN European Pediatric Dialysis Working Group
Jul 12, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Gaëlle AubertinMichel Fischbach
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Jul 21, 2011·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Renske RaaijmakersCornelis H Schröder
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Apr 17, 2015·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Julia ThumfartDominik Müller
Oct 11, 2016·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Claus Peter Schmitt, Christoph Aufricht
Feb 6, 2017·Seminars in Nephrology·Yong-Lim Kim, Wim Van Biesen
Dec 1, 2017·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Amadou SowOlivier Devuyst
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Nov 17, 2020·Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis·Jacek WaniewskiBengt Lindholm
Jul 9, 2021·Circulation Research·Maria BartosovaClaus Peter Schmitt

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