Passlick-Deetjen J, Kirchgessner J
Fresenius AG, Bad Homburg, Germany.
Perit Dial Int. 1996;16 Suppl 1:S109-13.
For a long time bicarbonate, the physiological buffer of the body, was suggested to be the best buffer for peritoneal dialysis. However, since the production of bicarbonate-containing solutions is associated with technical problems, lactate was favored. To avoid the well-known disadvantages of lactate solution concerning biocompatibility and possible metabolic side effects, different attempts have been made to use bicarbonate as a buffer in peritoneal dialysis. One of the major approaches was the total replacement of lactate by bicarbonate combined with storage of the fluid in a specially designed double-chamber bag. Further solutions of the above-mentioned problem were the on-line preparation of bicarbonate fluids for intermittent peritoneal dialysis, the addition of bicarbonate just before use, the combination of bicarbonate with organic acids, or its combination with the dipeptide glycylglycine as a stabilizing agent. By now, the beneficial effect of the neutral bicarbonate fluid, for example, on cell viability and cell functions, has been demonstrated in many different in vitro and animal studies. However, only few reports on clinical experience have been published. These investigations demonstrated independently that bicarbonate fluids diminish inflow pain, are well tolerated by the patients, and may correct metabolic acidosis of uremic patients. A controlled randomized multicenter trial using 34 mmol/L bicarbonate for at least three months confirmed that bicarbonate is as efficacious as lactate in equimolar concentrations. Concomitant investigations on energy metabolism and redox state of red blood cells and phospholipid secretion of mesothelial cells additionally demonstrated the improvement of cell function with bicarbonate solutions. For some patients with severe metabolic acidosis the bicarbonate concentration used in the multicenter trial seemed to be too low. Thus, a fluid containing a higher bicarbonate concentration was tested in a pilot study resulting in the expected significant increase of arterial bicarbonate levels. In summary, bicarbonate-containing peritoneal dialysis solutions are a promising alternative to lactate, especially if bicarbonate concentrations are adjusted individually to the patient's need.
长期以来，作为人体生理缓冲剂的碳酸氢盐被认为是腹膜透析的最佳缓冲剂。然而，由于含碳酸氢盐溶液的生产存在技术问题，乳酸盐更受青睐。为避免乳酸盐溶液在生物相容性和可能的代谢副作用方面的众所周知的缺点，人们进行了不同尝试，以在腹膜透析中使用碳酸氢盐作为缓冲剂。主要方法之一是用碳酸氢盐完全替代乳酸盐，并将液体储存在专门设计的双腔袋中。上述问题的其他解决方案包括为间歇性腹膜透析在线制备碳酸氢盐溶液、在使用前添加碳酸氢盐、将碳酸氢盐与有机酸结合，或与二肽甘氨酰甘氨酸结合作为稳定剂。到目前为止，在许多不同的体外和动物研究中已证明中性碳酸氢盐溶液具有有益作用，例如对细胞活力和细胞功能的影响。然而，关于临床经验的报道很少。这些研究独立表明，碳酸氢盐溶液可减轻流入痛，患者耐受性良好，并且可能纠正尿毒症患者的代谢性酸中毒。一项使用34 mmol/L碳酸氢盐至少三个月的对照随机多中心试验证实，等摩尔浓度的碳酸氢盐与乳酸盐一样有效。同时对红细胞能量代谢和氧化还原状态以及间皮细胞磷脂分泌的研究进一步证明了碳酸氢盐溶液可改善细胞功能。对于一些严重代谢性酸中毒患者，多中心试验中使用的碳酸氢盐浓度似乎过低。因此，在一项试点研究中测试了一种含更高碳酸氢盐浓度的溶液，结果动脉血碳酸氢盐水平出现了预期的显著升高。总之，含碳酸氢盐的腹膜透析液是乳酸盐的一种有前景的替代品，尤其是如果根据患者需求单独调整碳酸氢盐浓度的话。
