Nolph K D, Twardowski Z J, Khanna R, Prowant B F, Ponferrada L P, Schmidt L M, Moore H L
Department of Medicine, University of Missouri Health Sciences Center, Columbia 65212.
Perit Dial Int. 1990;10(2):161-4.
To see if rapid lactate absorption on tidal peritoneal dialysis (TPD) would overwhelm D-lactate metabolism using racemic lactate and/or L-lactate metabolism using all L-lactate, five patients underwent 8-h TPD treatments with racemic lactate solution one day and with L-lactate another. Lactate concentrations (total) were 40 mmole/L, flow rates 27.3 L/8 h, tidal and reservoir volumes each 1.5L, tidal cycles 24-26 min, and net ultrafiltration per tidal cycle 70 to 99 mL.
Mean absorptions of D and L-lactate were 24.2 and 25.1%, respectively, compared to glucose at 14.6%. Urea clearances averaged 21.4 mL/min. Mean blood D-lactates at baseline were 0.6 +/- 0.5 SD mmole/L and after 8 h of TPD were 0.6 +/- 0.4 and 0.7 +/- 0.3 using L-lactate and racemic solutions, respectively; similar values for L-lactate were 1.2 +/- 0.3 at baseline and 1.2 +/- 0.3 and 1.2 +/- 0.5 after 8 h with L-lactate and racemic solutions. delta blood pH values were + 0.02 +/- 0.01 and + 0.04 +/- 0.03, while delta bicarbonate values were + 1.7 +/- 0.9 and + 0.7 +/- 1.0 for the all L and racemic studies, respectively. The total mmoles of L-lactate absorbed per 8 h of TPD with all L solution (greater than 300 mmoles) are greater than ever reported for peritoneal dialysis, but did not increase blood lactate levels. It would seem that either type of solution is suitable for TPD. Absorptions and metabolic rates are similar for L-Lactate and D-Lactate.
为了探究潮式腹膜透析（TPD）过程中乳酸的快速吸收是否会使外消旋乳酸的D-乳酸代谢不堪重负，以及使用全L-乳酸时L-乳酸的代谢情况，五名患者分别在一天内接受了8小时的外消旋乳酸溶液TPD治疗，另一天接受了L-乳酸治疗。乳酸浓度（总量）为40毫摩尔/升，流速为27.3升/8小时，潮气量和储液量均为1.5升，潮式周期为24 - 26分钟，每个潮式周期的净超滤量为70至99毫升。
与葡萄糖的14.6%相比，D-乳酸和L-乳酸的平均吸收率分别为24.2%和25.1%。尿素清除率平均为21.4毫升/分钟。使用L-乳酸和外消旋溶液进行8小时TPD后，基线时的平均血液D-乳酸水平分别为0.6±0.5标准差毫摩尔/升，使用L-乳酸溶液时为0.6±0.4，使用外消旋溶液时为0.7±0.3；L-乳酸的类似值在基线时为1.2±0.3，使用L-乳酸溶液和外消旋溶液8小时后分别为1.2±0.3和1.2±0.5。血液pH值变化分别为+0.02±0.01和+0.04±0.03，而在全L和外消旋研究中，碳酸氢盐变化值分别为+1.7±0.9和+0.7±1.0。使用全L溶液进行8小时TPD吸收的L-乳酸总毫摩尔数（大于300毫摩尔）高于以往报道的腹膜透析情况，但并未提高血液乳酸水平。似乎两种类型的溶液都适用于TPD。L-乳酸和D-乳酸的吸收率和代谢率相似。
