Improvement in acid/base status and nutrition in peritoneal dialysis patients

The aim of this study was to assess the possible benefits, in terms of nutritional state and morbidity, of improved correction of metabolic acidosis (MA) in the first year of treatment with peritoneal dialysis (PD).;Two hundred consecutive new PD patients were randomised, in a single-blind fashion, to receive a high (HA: lactate 40 mmol/L) or low (LA: lactate 35 mmol/L) alkali dialysate, and studied for one year.;At one year, the venous serum bicarbonate and arterial pH were 7.44 0.004 and 27.2 0.3 mmol/L in the HA group, and 23.0 0.3 mmol/L and 7.4 0.004 in the LA group (both p<0.001).;At one year, the increase in body 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 circumference in the HA patients (1.26 0.16 cm) was significantly higher than the increase in the LA patients (0.61 0.16 cm) (p<0.05). The increases 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 was 37.8 0.4 g/dl at one year in the HA group, and 38.2 0.5 g/dl 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 different.;There were less hospital admissions in the HA group (1.13 0.16 per patient) compared to the LA group (1.71 0.22 per patient) (p<0.05). The HA patients spent less days in hospital than the LA patients (16.4 1.4 days vs 21.2 1.9 days; p<0.05).;It is concluded that better correction of MA leads to greater increases in body weight and midarm circumference, but not triceps skinfold thickness, in the first year of PD. The improvement in morbidity, in terms of number of admission and days in hospital per year, may be associated with the improvement in nutritional state.