Acetate-Free Biofiltration Versus Online Acetate-Free Hemodiafiltration in Patients at High Risk of Hemodialysis Intolerance

Abstract

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Can regional anticoagulation with calcium‐free dialysate be extended to maintenance hemodialysis?

“…36 Apter et al recently showed that the incidence of intradialytic hypotension in patients at high risk of hemodialysis intolerance is lower during AFB than during acetate-free hemodiafiltration, suggesting that some of the benefits of AFB are related to its acid-free rather than acetate-free nature. 37 During regional anticoagulation with calcium-free dialysate, acidification of the dialysate is also not necessary because calcium and bicarbonate are not present simultaneously in the dialysate, as in AFB and DCB. This acidification can be avoided by substituting trisodium citrate for citric acid in the concentrate used to supply the dialysate.…”

“…Apter et al. recently showed that the incidence of intradialytic hypotension in patients at high risk of hemodialysis intolerance is lower during AFB than during acetate‐free hemodiafiltration, suggesting that some of the benefits of AFB are related to its acid‐free rather than acetate‐free nature 37 …”

Acid-Free Biocompatible Hemodiafiltration

“…Citrate-based treatments, despite being acetate-free, show increased partial pressure of CO 2 in blood exiting the extracorporeal circuit and are associated with hemodynamic instability [7]. Cardiac output and peripheral vascular resistance do not change by replacing acetic with citric acid [8], but a significant decrease in IH incidence occurs if acid is removed by dialysate: patients receiving HDF with acetate-free chloride-based dialysate improved their hemodynamic stability during 3-month period of AFB [9]. Taken all together, these evidence suggest that hemodynamic tolerance is not related to acetate anion but to the lack of acid, regardless of what it is.…”