An Amino Acid-Based Peritoneal Dialysis Fluid Buffered with Bicarbonate versus Glucose/Bicarbonate and Glucose/Lactate Solutions: An Intraindividual Randomized Study
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Titel:
An Amino Acid-Based Peritoneal Dialysis Fluid Buffered with Bicarbonate versus Glucose/Bicarbonate and Glucose/Lactate Solutions: An Intraindividual Randomized Study
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<jats:sec><jats:title>Objective</jats:title><jats:p> In order to study acute metabolic changes and peritoneal transport, amino acids as osmotic agent and bicarbonate as buffer were tested as new agents in peritoneal dialysis (PD) solutions. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> In a prospective, cross-over, randomized, intraindividual study, we investigated the acute metabolic changes following the application of three different PD fluids: (1) a 1% amino acid-based PD solution buffered with bicarbonate (34 mmol/L) (Amino/Bic); (2) a 1.5% glucose anhydrous-containing bicarbonate-buffered solution (34 mmol/L) (Glu/Bic); and (3) a conventional 1.5% glucose anhydrous-based dialysis solution with lactate (35 mmol/L) (Glu/Lac). </jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p> University medical center. </jats:p></jats:sec><jats:sec><jats:title>Patients</jats:title><jats:p> Ten nondiabetic patients stable on continuous ambulatory peritoneal dialysis (time on dialysis, 42.5 ± 21.5 months) were treated and monitored with the test solutions over a 6-hour dwell. Three different study days followed in a randomized order for each patient (interval of 1 – 3 weeks). Blood and dialysate samples were taken at 0.25, 0.5, 1, 2, 4, and 6 hours. Immediately after the 1-hr dwell (and after sampling), the patients received a standardized breakfast, thereby simulating usual food intake. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Following the application of Amino/Bic a significant increase in plasma amino acids occurred, with peak levels (maximum 250% increase) after either the 1-hr or the 2-hr dwell. Before taking the standard meal (0.5 hr, 1 hr), the mean serum glucose level with Amino/Bic was 8% ± 13% lower than with Glu/Bic ( p = 0.06) and 14% ± 8% lower than with Glu/Lac ( p < 0.01). This difference was still significant after the standard breakfast and also for the whole dwell (average serum glucose 0.5 – 6 hr: Amino/Bic, 91 ± 6 mg/dL; Glu/Bic, 100 ± 8 mg/dL; Glu/Lac, 102 ± 7 mg/dL; p < 0.01 MANOVA). The serum insulin profiles did not differ between the fluids. A transperitoneal protein- and amino acid-related nitrogen loss of 0.49 ± 0.18 g and 0.48 ± 0.12 g per dwell was measured using Glu/Bic and Glu/Lac, while a positive balance of 1.80 ± 0.43 g was achieved with Amino/ Bic. The parameters of acid-base status (pH, HCO<jats:sub>3</jats:sub>, pCO<jats:sub>2</jats:sub>) remained nearly unchanged in the blood, irrespective of the solution used, while dialysate values differed markedly. No significant differences with respect to ultrafiltration (Amino/Bic, –68 ± 199 mL/6hr; Glu/Bic, –51 ± 89 mL/6hr; Glu/ Lac, –2 ± 134 mL/6hr) and peritoneal creatinine clearance (Amino/Bic, 4.9 ± 0.6 mL/min; Glu/Bic, 5.1 ± 0.6 mL/min; Glu/ Lac, 4.8 ± 0.5 mL/min) were measured. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Our results demonstrate that ultrafiltration and small solute clearance over a 6-hour dwell with a 1% Amino/Bic solution were comparable to those of 1.5% Glu/Bic and 1.5% Glu/Lac. Reduced serum glucose concentrations were found with Amino/Bic and this fluid compensated the transperitoneal protein-nitrogen loss of about three glucose dwells. Bicarbonate buffering (34 mmol/L) did not change blood acid-base status combined with either glucose or amino acids. </jats:p></jats:sec>