Abstract
The currently used CAPD dialysate, the slight acidity of which prevents glucose degradation, may cause peritoneal membrane problems as a consequence of repeated administrations. To evaluate the effects of neutral CAPD dialysate in long-term application, a 5-month clinical study was performed with dialysate neutralized by an NaHCO3 addition to the system.
The neutral CAPD dialysate was prepared by adding 12ml of 8.4% NaHCO3 solution to Dianeal PD-1 (Baxter) through the injection port by use of a reconstituting device (Baxter) just before every administration. The final pH was 6.8 and the NaHCO3 concentration was 6mmol/l The final lactate concentration was 35mmol/l and that of Na was 138mEq/l A 5-month clinical study was performed on 8 wellcontrolled CAPD patients comparing Dianeal PD-2 as pre-and post-control dialysates. The changes in blood chemistry, drainage chemistry and white blood cell counts in the drainage were measured, and subjective symptoms were recorded by means of questionnaires to patients.
Blood HCO3- levels significantly improved during the use of the neutral dialysate. Blood Na, Cl and Mg levels, and the drainage volume significantly increased. Negative Na-balance was increased during the administration of the neutral dialysate. Levels of blood IgG slightly decreased. The total white blood cell count in the drainage decreased. Other examined parameters changed little. As for the changes in subjective symptoms, abdominal bloating, abdominal pain at instillation time, nausea and headache were improved. No side effects, including peritonitis, occurred when the neutral dialysate was used, but there were some episodes of peritonitis in the pre-and post-control tests with use of Dianeal PD-2.
The CAPD dialysate neutralized by NaHCO3 seems to have a less stimulatory effect on the peritoneal membrane and does not after the theraputic effects of CAPD. The neutral CAPD dialysate seems have certain advantages in the long-term treatment of CAPD patients.
