Short-term correction of metabolic acidosis in normal and uremic subje
cts has been shown to decrease protein degradation, but the lone-term
effects of better correction of acidosis on nutrition in ESRF are unkn
own. The aim of this study was to assess the possible benefits, in the
nutritional state and morbidity, of improved correction of acidosis i
n the first year of treatment with continuous ambulatory peritoneal di
alysis (CAPD). Two hundred consecutive new CAPD patients were randomiz
ed, in a single-blind fashion, to receive a high (HA; lactate 40 mmol/
liter) or low (LA; lactate 35 mmol/liter) alkali dialysate for one yea
r. Calcium carbonate and sodium bicarbonate were also used to correct
acidosis in the HA group. Ar one year, the venous serum bicarbonate an
d arterial pH were 7.44 +/- 0.004 and 27.2 +/- 0.3 mmol/liter in the H
A group, and 23.0 +/- 0.3 mmol/liter and 7.4 +/- 0.004 in the LA group
(P < 0.001). Dialysis dose, at one year or at the point of leaving th
e study (HA 8.0 +/- 0.1 liters/day vs. LA 8.5 +/- 0.3 liters/day) was
not significantly different (P = 0.18). At one year, the increase in b
ody weight in the HA group (6.1 +/- 0.66 kg) was higher than in the LA
group (3.71 +/- 0.56 kg, P < 0.05). The increase in midarm circumfere
nce in the HA patients (1.26 +/- 0.16 cm) was significantly higher tha
n the increase in the LA patients (0.61 +/- 0.16 cm, P < 0.05). The in
crease in triceps skinfold thickness were not significantly different
(HA 2.5 +/- 0.41 mm vs. LA 1.24 +/- 0.38 mm, P = 0.1). Serum albumin w
as 37.8 +/- 0.4 g/dl at one year in the HA group, and 38.2 +/- 0.5 g/d
l in the LA group (NS). Dietary protein intake at one year (HA 0.9 +/-
0.2 g/kg/day vs. LA 1.0 +/- 0.1 g/kg/day) was not significantly diffe
rent. There were fewer hospital admissions in the HA group (1.13 +/- 0
.16 per patient per year) compared to the LA group (1.71 +/- 0.22 per
patient per year, P < 0.05). The HA patients spent less days in hospit
al per year than the LA patients (16.4 +/- 1.4 days/year vs. 21.2 +/-
1.9 days/year; P < 0.05). It is concluded that better correction of me
tabolic acidosis leads to greater increases in body weight and midarm
circumference, but not triceps skinfold thickness, in the first year o
f CAPD. The improvement in morbidity, in terms of number of admissions
and days in hospital per year, may be associated with the improvement
in nutritional state.