OPTIMIZATION OF ACIDOSIS CORRECTION IN PERITONEAL-DIALYSIS PATIENTS

There is experimental and clinical evidence that metabolic acidosis af fects several organs and physiological functions. Thus correction of a cid base status in uremic patients represents one of the basic aims of dialysis. CAPD enables a certain degree of correction. However a subs tantial amount of patients still present acid base derangements and, i n large series, a wide variability of plasma bicarbonate levels has be en recorded. Oral base supplementation could be effective in correctio n of the prevalent acid base alteration that is metabolic acidosis. Ho wever, the potential undesirable effects of the resulting sodium and c alcium supplementation should be carefully evaluated. Plasma bicarbona te value in CAPD patients reflects body base balance that depends on b uffer gain from dialysis solution and on buffer lost for neutralizing metabolic acid production. An increase in plasma bicarbonate could be achieved by changing the buffer content in the fresh dialysis solution s. In a short term pilot study, a 39 mmol/L bicarbonate buffered CAPD solution was demonstrated to increase plasma bicarbonate concentration in CAPD patients as compared to a 34 mmol/L bicarbonate buffered solu tion. The majority of patients achieved during the study a normal acid base status. These results need to be confirmed by further and long t erm studies.