La Milia Vincenzo, Limardo Monica, Crepaldi Monica, Locatelli Francesco
Department of Nephrology, Dialysis and Kidney Transplantation, A. Manzoni Hospital, Lecco, Italy.
Perit Dial Int. 2009 Mar-Apr;29(2):158-62.
To investigate the possible effects of different concentrations of ionized sodium (NaI) on peritoneal ultrafiltration (UF) rate using lactate (Lac) and lactate/bicarbonate (Lac/Bic) dialysis solutions.
Two random consecutive (after an interval of 48 hours) peritoneal equilibration tests (PETs) were performed in 13 patients (4 males and 9 females) on regular continuous ambulatory peritoneal dialysis (PD) treatment for at least 3 months. Two different PD solutions containing anhydrous glucose 3.86% were used: a 40 mmol/L Lac solution and a 15/25 mmol/L mixed Lac/Bic solution. Concentrations of total sodium (NaT) and NaI were measured by flame photometer and direct ion-selective electrode respectively.
Dialysate concentrations of NaT were not different during PETs using Lac and Lac/Bic. Dialysate concentrations of NaI in fresh PD solutions were different (133.3 +/- 1.7 vs 128.2 +/- 3.9 mmol, p < 0.0001); however, these differences disappeared just after the end of the infusion of the fresh solutions. Peritoneal UF rate was not significantly different during PETs using Lac versus Lac/Bic (609 +/- 301 mL vs 542 +/- 362 mL). The dialysate-to-plasma ratios of sodium concentrations at 60 minutes of the PETs (which are expressions of free water transport) were not different using Lac versus Lac/Bic (0.89 +/- 0.04 vs 0.89 +/- 0.04 respectively, p = 0.96). All the other classical parameters of the PET were not different between Lac and Lac/Bic.
The higher dialysate concentrations of NaI due to lower dialysate pH and consequently the higher effective osmolality of the fresh Lac PD solutions did not influence peritoneal UF rate, probably because of the fast reduction of NaI concentrations due to rapid correction of dialysate pH at the end of the infusion of Lac solutions into the peritoneal cavity.
使用乳酸盐（Lac）和乳酸盐/碳酸氢盐（Lac/Bic）透析液，研究不同浓度的离子化钠（NaI）对腹膜超滤（UF）率的可能影响。
对13例（4例男性和9例女性）接受规律持续性非卧床腹膜透析（PD）治疗至少3个月的患者，连续进行两次随机（间隔48小时）腹膜平衡试验（PET）。使用两种不同的含3.86%无水葡萄糖的PD溶液：一种40 mmol/L的Lac溶液和一种15/25 mmol/L的混合Lac/Bic溶液。分别通过火焰光度计和直接离子选择电极测量总钠（NaT）和NaI的浓度。
在使用Lac和Lac/Bic进行PET期间，透析液中NaT的浓度没有差异。新鲜PD溶液中NaI的透析液浓度不同（133.3±1.7 vs 128.2±3.9 mmol，p<0.0001）；然而，在新鲜溶液输注结束后，这些差异就消失了。在使用Lac与Lac/Bic进行PET期间，腹膜UF率没有显著差异（609±301 mL vs 542±362 mL）。PET 60分钟时透析液与血浆钠浓度之比（即自由水转运的指标）在使用Lac与Lac/Bic时没有差异（分别为0.89±0.04 vs 0.89±0.04，p = 0.96）。PET的所有其他经典参数在Lac和Lac/Bic之间没有差异。
由于透析液pH值较低，新鲜Lac PD溶液的有效渗透压较高，导致透析液中NaI浓度较高，但这并未影响腹膜UF率，可能是因为在将Lac溶液注入腹腔结束时，透析液pH值迅速校正，NaI浓度迅速降低。
