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Acid-base homeostasis in peritoneal dialysis patients.

During both IPD and CAPD, acetate or lactate enters the patient, is metabolized, and generates bicarbonate, while bicarbonate is simultaneously being lost into the dialysate. The net balance depends on the pre-dialysis serum bicarbonate of the patient, dialysate buffer concentration, dialysate dwell time and metabolic rate of acetate or lactate (6). Dixon et al (7) studied lactate transfer during IPD using 2L dialysate volume, 1 hour dwell time, and a 45 mEq/L dialysate lactate concentration. Blood lactate and pyruvate rose to 10.4 mg% and 0.56 mg% over 43 hours respectively, and 70 mEq of lactate were absorbed (80%) during a single exchange. 25 to 30 mEq bicarbonate were simultaneously lost into the dialysate per exchange and blood bicarbonate progressively rose. With 5Uhour dialysate flow and zero dwell time, similar results were obtained (8). Rubin et al (9), however, have shown that the clearance of L(+) lactate is significantly greater than D(-), suggesting that the absorption characteristics of the peritoneum are stereospecific. This may have important implications for formulation of more efficient buffering dialysates containing only L(+) lactate or when other organic anions may be substituted. Acetate kinetics during IPD are similar to those of lactate. 85-90% of dialysate acetate is absorbed during 5U hour, zero-dwell time dialysis and approximately 71% of the acetate is metabolized to bicarbonate. Bicarbonate removal by dialysis and net weekly buffer gain is similar with acetate and lactate. The International Journal Of Artificial Organs / Vol. 7 no. 4, 1984/ p.p. 175-176