Tidal Peritoneal Dialysis with Racemic or L-Lactate Solutions

Abstract

To see if rapid lactate absorption on tidal peritoneal dialysis (TPD) would overwhelm D-Iactate metabolism using racemic lactate andlor L-Iactate metabolism using all L-Iactate, five patients underwent a- h TPD treatments with racemic lactate solution one day and with L-Iactate another. Lactate concentrations (total) were 40 mmolelL, flow rates 27.3 LIB h, tidal and reservoir volumes each 1.5L, tidal cycles 24–26 min, and net ultrafiltration per tidal cycle 70 to 99 mL. Results: Mean absorptions of D and L-Iactate were 24.2 and 25.1%, respectively, compared to glucose at 14.6%. Urea clearances averaged 21.4 mLlmin. Mean blood D-Iactates at baseline were 0.6 ± 0.5 SD mmolelL and after a h of TPD were 0.6 ± 0.4 and 0.7 ± 0.3 using L-Iactate and racemic solutions, respectively; similar values for L-Iactate were 1.2 ± 0.3 at baseline and 1.2 ± 0.3 and 1.2 ± 0.5 after a h with L-Iactate and racemic solutions. d blood pH values were + 0.02 ± 0.01 and + 0.04 ± 0.03, while d 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-Iactate absorbed per a h of TPD with all L solution (>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.