Lactate or bicarbonate in dialysis fluid for daily home hemodialysis: advantages and disadvantages
Keywords:daily hemodialysis, low dialysate flow rate
The availability since the beginning of the 20th century of hemodialysis monitors similar to the cyclers used for automated peritoneal dialysis (space-saving and easy-to-handle monitors using a low volume of dialysis fluid and suitable for daily dialysis) has led to renewed interest in home hemodialysis. As in peritoneal dialysis, these cyclers use either lactate - an anion whose metabolism leads to bicarbonate regeneration - or bicarbonate in the dialysate. The purpose of this article is to review the advantages and disadvantages of these two types of alkalinizing anion. Whichever type of anion is used, it is important to avoid over-alkalinization of the patient. Lactate dialysate, which is less expensive and easier to handle, seems to be suitable for most patients, but its use in patients with abnormal liver function should be discouraged.
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