Background and objectives: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect. This study examines the effect of CD on dialysis efficiency, measured as eKt/Vurea, and predialysis concentrations of BUN, creatinine, phosphate, and -2 microglobulin in chronic dialysis units.Design, settings, participants, & measurements: Three outpatient chronic hemodialysis units with 142 patients were switched to CD for 6 mo. Using each patient's prior 6 mo on regular bicarbonate dialysate acidified by acetate (AD) as control, eKt/Vurea was compared with that of CD. Follow-up data for 7 mo after the study were collected from about one-half of the participants remaining on CD and the others returned to AD.Results: eKt/Vurea, increased (P < 0.0001) from pre-CD value of 1.51 ؎ 0.01 to 1.57 ؎ 0.01 with CD. During CD use -2 microglobulin levels declined (P ؍ 0.0001) from 28.1 ؎ 10.0 to 25.9 ؎ 10.0. Similarly, the concentrations of BUN, creatinine, and phosphate also decreased on CD (P < 0.008). In the poststudy period, eKt/Vurea for the patients staying on CD remained unchanged at 1.60 ؎ 0.17 versus 1.59 ؎ 0.18 (P ؍ NS), whereas in those returning to AD the eKt/Vurea decreased from 1.55 ؎ 0.20 to 1.52 ؎ 0.17 (P < 0.0001).Conclusions: Data suggest that CD use is associated with increased solute removal.
Dialyzer reuse is limited by the clotting of blood, which blocks the fibers and reduces the membrane surface area. Clotting during treatment may also reduce dialysis efficiency and potentially decrease delivered dose, Kt/V(urea). A new dialysate containing citric acid, instead of the standard acetic acid, as the acidifying agent has become available and is associated with reduced clotting during acute dialysis treatments. The effect of citric acid dialysate on dialyzer reuse was evaluated in this prospective, controlled, multicenter study involving maintenance hemodialysis patients. A total of 105 patients from five dialysis units were switched to the new dialysate and new dialyzers. Reuse outcome on the new dialysate was compared with the reuse on the regular acetic acid containing bicarbonate dialysate (controls). The overall reuse with citrate dialysate increased significantly from 15.1 +/- 9.4 to 18 +/- 10.0 (mean +/- SD) on regular and citrate dialysate, respectively (p = 0.0003). The most significant increase was seen in those patients who had limited reuse before the switch to citrate dialysate; 51, 59, and 134% increases occurred in those with 10 to 15, 5 to 10, and < 5 reuses at controls, respectively. Interestingly, the 10 patients with 10 or fewer reuses had significantly lower Kt/V(urea) at baseline (before the switch to citric acid dialysate) than those with > 10 reuses (1.23 +/- 0.23 vs. 1.47 +/- 0.23, respectively, p = 0.009). The Kt/V(urea) increased to 1.41 +/- 0.31 after the switch in the low-reuse group but the increase did not reach statistical significance (p = 0.07). The results from this study show that citric acid-containing dialysate is associated with increase in dialyzer reuse and appears to be related to reduced clotting.
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