#3853 THE EFFECT OF PERITONEAL CAVITY FLUSHING ON ACID BASE BALANCE OF PERITONEAL DIALYSIS PATIENTS

Abstract

Abstract Background and Aims Flushing peritoneal cavity with dialysis fluid with short time dwells it is a necessity in some cases for peritoneal dialysis patients. Such cases are overhydration with pulmonary congestion or peritonitis before the initiation of antibiotic treatment as an effort to reduce pain. The aim of this study was to investigate the effect of frequent exchanges with peritoneal dialysis (PD) fluid with bicarbonate as a buffer on acid base balance of peritoneal dialysis patients. Method This is a single center cohort study of 18 stable PD patients (m=10.f=8). Their median age was 57 (47, 71) years, their median PD duration was 33 (16, 89) months and they all fulfill the criteria for achieving adequacy targets [median Kt/V 2.17 (1.99, 3.3)] with good nutrition markers [ median albumin levels 3.9 (3.6, 4) gr/dl]. A sample of arterial blood gas (ABG) was taken from the patients before the procedure and after full drainage of the peritoneal cavity . The procedure included 4 times flushing of 1000 ml of dialysis fluid remaining for15 minutes In the peritoneal cavity each time . At the end of the procedure a new blood sample for ABG was taken. We used PD solution with bicarbonate as a buffer (34 mmol/Lt). We estimated the alterations of pH, of bicarbonate (HCO3-), of pCO2, of Base Excess(ΒΕ), of ionized calcium (iCa++) and lactate (Lac) Results Using the non parametric related samples Wilcoxon signed method we found a statistically significant increase in arterial HCO3- concentration between the values before and after the procedure [HCO3-before:25.4 (22, 28), HCO3after:26.5 (24, 29) mEq/lt-P = .023]. Likewise there was a statistically significant increase in BE with median values before the procedure 1 (-1.2,2.9) and after the flushing 2 (-0.6,3,8), P = .018. Even though there was a statistically significant increase in the bases expression of the acid base balance of the patients there wasn't any statistically significant alterations in pH levels- i.e. Alkalemia (pHbefore=7.41,pHafter=7.42 – P = .35) or pCO2 levels i.e. Compensatory Respiratory Acidosis (pCO2προ=40, pCO2μετα=40 – P = .179) nor to the levels of ionized calcium Conclusion Flushing of peritoneal cavity using peritoneal dialysis solution with bicarbonate as a buffer is safe and in this study was not correlated with the development of metabolic alkalosis