14807
document
Improved acidosis correction and recovery of mesothelial cell mass with neutral-pH bicarbonate dialysis solution among children undergoing automated peritoneal dialysis . Acid-base balance and peritoneal membrane longevity are of utmost relevance for pediatric patients undergoing peritoneal dialysis ( PD ) . PD fluids with neutral pH and reduced glucose degradation product contents are considered more biocompatible , because they preserve peritoneal cell functions in vitro . To investigate the clinical effects of a novel PD fluid buffered with 34 mM pure bicarbonate at neutral pH , a randomized , prospective , crossover comparison with conventional , acidic , 35 mM lactate PD fluid was performed for two consecutive 12-wk periods with 28 children ( age , 6 mo to 15 yr ) undergoing automated PD ( APD ) . Blood bicarbonate levels and arterial pH were significantly higher after 3 mo of bicarbonate PD ( 24.6 +/- 2.3 mM and 7.43 +/- 0.06 , respectively ) , compared with lactate PD ( 22.8 +/- 3.9 mM and 7.38 +/- 0.05 , respectively ; P < 0.05 ) . This effect was reversible among patients who returned from bicarbonate to lactate fluid . Low initial pH and young patient age independently predicted increased blood pH during bicarbonate APD . Peritoneal equilibration tests revealed subtle changes in solute transport , with a less steep creatinine equilibration curve during bicarbonate dialysis , suggesting reduced peritoneal vasodilation . The peritoneal release of carcinogen antigen-125 increased twofold during bicarbonate APD ( 29 +/- 15 versus 15 +/- 8 U/ml per 4 h , P < 0.01 ) , which is consistent with recovery of the mesothelial cell layer . This effect was fully reversed when the patients returned to lactate fluid . Effluent carcinogen antigen-125 levels were inversely correlated with peritoneal glucose exposure during lactate but not bicarbonate APD , indicating improved in vivo mesothelial cell tolerance of high-dose glucose with the neutral-pH PD fluid with reduced glucose degradation product content . Among children undergoing APD , neutral-pH , bicarbonate-buffered PD fluid provides more effective correction of metabolic acidosis and better preservation of peritoneal cell mass than do conventional , acidic , lactate-based fluids .
14808
Intervention_Pharmacological
neutral-pH bicarbonate dialysis solution
14809
Intervention_Physical
automated peritoneal dialysis
14810
Intervention_Physical
peritoneal dialysis ( PD )
14811
Intervention_Pharmacological
novel PD fluid buffered with 34 mM pure bicarbonate at neutral pH
14812
Intervention_Pharmacological
conventional , acidic , 35 mM lactate PD fluid
14813
Intervention_Physical
automated PD ( APD )
14814
Intervention_Pharmacological
bicarbonate PD
14815
Intervention_Pharmacological
lactate PD
14816
Intervention_Pharmacological
neutral-pH PD fluid with reduced glucose degradation product content
14817
Intervention_Pharmacological
APD , neutral-pH , bicarbonate-buffered PD fluid
14818
Intervention_Pharmacological
conventional , acidic , lactate-based fluids
14819
Outcome_Other
effects
14820
Outcome_Physical
Blood bicarbonate levels
14821
Outcome_Physical
arterial pH
14822
Outcome_Mental
higher
14823
Outcome_Physical
bicarbonate PD
14824
Outcome_Physical
lactate PD
14825
Outcome_Physical
initial pH
14826
Outcome_Physical
blood pH
14827
Outcome_Physical
bicarbonate APD
14828
Outcome_Physical
subtle changes in solute transport
14829
Outcome_Physical
steep creatinine equilibration curve
14830
Outcome_Physical
peritoneal release of carcinogen antigen-125 increased
14831
Outcome_Physical
Effluent carcinogen antigen-125 levels
14832
Participant_Age
children
14833
Participant_Condition
automated peritoneal dialysis
14834
Participant_Age
pediatric
14835
Participant_Condition
peritoneal dialysis
14836
Participant_Condition
PD
14837
Participant_Sample-size
28
14838
Participant_Age
children
14839
Participant_Age
6 mo to 15 yr
14840
Participant_Condition
automated PD
14841
Participant_Condition
APD
14842
Participant_Age
children
14843
Participant_Condition
APD