Bicarbonate versus lactate solutions for acute peritoneal dialysis: Cochrane systematic review
Assessed as up to date: 2014/05/06
The high mortality rate among critically ill patients with acute kidney injury (AKI) remains an unsolved problem in intensive care medicine, despite the use of renal replacement therapy (RRT). Increasing evidence from clinical studies in adults and children suggests that the new peritoneal dialysis (PD) fluids may allow for better long-term preservation of peritoneal morphology and function. Formation of glucose degradation products (GDPs) can be reduced and even avoided with the use of newer "biocompatible" solutions. However, it is still unclear if there are any differences in using conventional (lactate) solutions compared with low GDP (bicarbonate) solutions for acute PD.Objectives
To look at the benefits and harms of bicarbonate versus lactate solutions in acute PD.Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1966), EMBASE (from 1980), Latin American and Caribbean Health Sciences Literature Database LILACS (from 1982), and reference lists of articles.
Date of last search: 6 May 2014.Selection criteria
Randomised controlled trials (RCTs) comparing bicarbonate to lactate solution for acute PD.Data collection and analysis
Two authors independently assess the methodological quality of studies. One author abstracted data onto a standard form, and a second author checked data extraction. We used the random-effects model and expressed the results as relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).Main results
We included one study (20 patients) in this review. In shock patients, bicarbonate did not differ from lactate with respect to mortality (RR 0.50, 95% CI 0.06 to 3.91); however there were significant differences in blood lactate (MD -1.60 mmol/L, 95% CI -2.04 to -1.16), serum bicarbonate (MD 5.00 mmol/L, 95% CI 3.26 to 6.74) and blood pH (MD 0.12, 95% CI 0.06 to 0.18). In non-shock patients there was a significance difference in blood lactate (MD -0.60 mmol/L, 95% CI -0.85 to -0.35) but not in serum bicarbonate (MD 1.10 mmol/L, 95% CI -0.27 to 2.47) or blood pH (MD -0.02, 95% CI -0.02 to -0.06). Other outcomes could not be analysed because of the limited data available.Authors' conclusions
There is no strong evidence that any clinical advantage for patients requiring acute PD for AKI when comparing conventional (lactate) with low GDP dialysis solutions (bicarbonate).
Bai Zheng Gang, Yang KeHu, Tian Jin Hui, Ma Bin, Liu Yali, Jiang Lei, Tan Jiying, Liu Tian Xi, Chi Iris
Two dialysis solutions for acute peritoneal dialysis
Acute kidney injury (AKI) can be treated with either bicarbonate or lactate in acute peritoneal dialysis (PD). The aim of this review was to compare the effectiveness of bicarbonate versus lactate solution.
We identified only one small randomised controlled trial (RCT) (20 patients) after an extensive literature search, and we found no difference between bicarbonate and lactate for clinically important outcomes, such as mortality and adverse events. An initial reported benefit of bicarbonate over lactate was not confirmed by subsequent studies. In this systematic review of one RCT of patients with AKI, no significance difference was demonstrable between these two dialysis solutions.
Implications for practice
Based upon data from one small RCT, bicarbonate did not have significant advantages over lactate in terms of clinical outcomes. But it may be considered in some special states of patients based on their acute PD characteristics; for instance:
- in poor tissue-perfusion states such as shock, lactic acidosis and multiple organ failure; and
- those in employment or study due to its psychosocial advantages.
Because this conclusion is based on only one study, the available evidence should be weighed in the context of patient considerations in the clinical setting.
Implications for research
Further large-scale RCTs should be conducted in AKI patients who are contra-indicated or incapable of being treated with HD for a period of time. There should be much more concern when using acute PD during this critical period. Meanwhile, future research should focus on the assessment of quality of life and serious adverse events.Get full text at The Cochrane Library
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