Citrate versus Acetate-Based Dialysate in On-Line Haemodiafiltration. A Prospective Cross-Over Study

Abstract

Background and Aims: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). Methods: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. Results: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. Conclusion: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.

Bicarbonate Balance and Prescription in ESRD

“…Greater buffer delivery and better correction of acidosis would be expected, but this has not been a consistent finding. [81][82][83][84][85]…”

Is Anticoagulation Discontinuation Achievable with Citrate Dialysate during HDF Sessions?

“…The impact of citrate dialysate containing the same concentration of calcium on the predialysis PTH serum concentration raises questions; it remained stable in some studies [ 18 , 21 ] or increased in others [ 20 ]. If calcium concentration in citrate dialysate has been increased by 0.15 mEq then postdialysis serum calcium lowers [ 5 , 19 ] and if it has been increased by 0.25 mEq, serum calcium remains stable during dialysis session [ 8 ]. PTH has never been studied if calcium concentration is increased in citrate dialysate.…”

“…Consequently, citrate dialysate, known for its improved biocompatibility, has been developed for few years. Compared to acetate, citrate was described to improve depuration of small and large molecules [ 5 – 7 ], to induce less inflammation [ 5 , 8 – 10 ], to be more physiological on acid-base balance [ 5 , 11 ], and to improve nutritional status [ 12 ]. It results in a better clinical tolerance of the dialysis sessions [ 11 ].…”

Acid ion modification in a dialysis fluid

“…Умеренный антикоагулянтный эффект цитрата был обнаружен еще в одном исследовании [18]; кроме того, авторы отмечали снижение предиализных показателей Среактивного белка и β 2 -микроглобулина, отсутствие последиализной гипокальциемии и умеренные концентрации цитратного иона (0,29 ммоль/л при безопасной для регионарной цитратной антикоагуляции концентрации = 0,89 ммоль/л). Снижение концентраций С-реактивного белка и β 2 -микроглобулина было отмечено и при использовании цитратной ДЖ для гемодиафильтрации [19]. Kuragano et al в течение 4 месяцев после перевода 29 пациентов на лечение диализом с цитратной ДЖ отмечали нормализацию предиализного уровня бикарбоната у больных с исходно низким его уровнем, снижение потребности в эритропоэзстимулирующих препаратах и повышение концентрации альбумина.…”