Lactate versus Bicarbonate-Based Peritoneal Dialysis Solutions

C onventional acidic lactate-based peritoneal solutions (LB-fluids) occasionally induce slight to moderate pain during the initiation of continuous ambulatory peritoneal dialysis (CAPD) treatment, pain that can be avoided by adding bicarbonate to the bags prior to use, thereby neutralizing the fluids (1,2). The same neutralization procedure may often be advantageously used in patients who are unable to ultrafiltrate during CAPD and in patients with chronic irritation of the peritoneum, resulting in cloudy effluent due to increased amounts of cells and fibrin/protein in the dialysate. These basic clinical observations indicate that the LB-fluids to some degree are not biocompatible. The risk is that over the long term, this incompatibility may result in sclerosis of the peritoneal membrane.