Comparison of Acetate‐Free Citrate Hemodialysis and Bicarbonate Hemodialysis Regarding the Effect of Intra‐Dialysis Hypotension and Post‐Dialysis Malaise

Abstract

Compared with acetate dialysate, bicarbonate dialysate has shown beneficial effects in reducing the morbidity associated with dialysis, but a small amount of acetate in bicarbonate dialysate may evoke hypotension or malaise. Acetate-free citrate hemodialysis (AFHD) may avoid these problems. In 44 hemodialysis patients bicarbonate hemodialysis (BHD) was conducted for three months, followed by a switch to AFHD for three months, and a further switch to bicarbonate hemodialysis (ReBHD). In BHD, AFHD and ReBHD, intra-dialysis hypotension and post-dialysis malaise were determined (hypotension: intra-dialysis systolic blood pressure (SBP) was expressed as a percentage of SBP at the start of hemodialysis, malaise was assessed by a self-reported 0 to 3 scale, 0: absence of malaise, 3: unbearable malaise). Compared with BHD, AFHD patients complained of less malaise but the intra-dialysis blood pressure change did not differ significantly (malaise: BHD 0.73 ± 0.76 vs. AFHD 0.32 ± 0.47, P < 0.0001, end hemodialysis SBP: BHD 93.6 ± 8.9 vs. AFHD 93.8 ± 10.1, P = NS). After switching to ReBHD from AFHD, the malaise score increased (AFHD 0.32 ± 0.47 vs. ReBHD 0.77 ± 0.89, P < 0.0001) and the intra-dialysis blood pressure dropped markedly (end hemodialysis SBP: AFHD 93.8 ± 10.1 vs. ReBHD 87.3 ± 10.5, P < 0.0001). Malaise was very severe in five patients who could not continue ReBHD. After ten days under ReBHD, ReBHD was changed to AFHD again in all patients. Although the exact mechanisms are not known, AFHD may be preferable to BHD to prevent hemodialysis-induced hypotension and malaise.

Acute Intradialytic Cardiac Function and Inflammatory Cytokine Changes During High‐Efficiency Online Hemodiafiltration With Acetate‐Free and Standard Dialysis Solutions

“…The present study was the first to explore intradialytic hemodynamic effects of AF dialysis solution in high‐efficiency online HDF. Although there was ample evidence that showed the benefit of AF solution on hemodynamic stability in HD and other HDF modes , the present study did not show additive hemodynamic benefits of the AF dialysis fluid in high‐efficiency online HDF. The changes of cardiac index, cardiac output, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and peripheral vascular resistance were comparable (Fig.…”

“…Second, the acetate concentration in the standard AC group in the present study was lower than previous studies (3.0 vs. 10.0–11.0 mEq/L) which could demonstrate the hemodynamic benefit of AF dialysis solution in HD . The lower acetate in standard AC dialysis solution might lessen the adverse effects of acetate in the AC group.…”

Líquido dializante con citrato frente a acetato en pacientes en hemodiafiltración on-line de alta eficacia: parámetros a estudio

“…El citrato es un metabolito con conocido poder anticoagulante capaz de reducir el potencial trombogénico del circuito extracorpóreo al limitar la disponibilidad de iones de calcio, que son un factor clave en la cascada de la coagulación, mejorando de éste modo el rendimiento El uso de un líquido de diálisis con citrato conlleva una reducción del malestar en los pacientes debido a la ausencia de acetato 11 , que se ha relacionado con diversos efectos clínicos adversos secundarios a su uso (dislipemia, depresión miocárdica, producción de citoquinas, vasodilatación e hipoxia), además de estar asociado a síntomas intradialíticos como mareo, nauseas, fatiga, hipotensión, etc. En nuestra serie no encontramos diferencias significativas en cuanto a hipotensiones y calambres entre los periodos de LDC y LDA, aunque el hecho de encontrar un mayor número de hipotensiones en el periodo de citrato puede estar relacionado con la inseguridad que vive el paciente ante el uso de materiales nuevos desconocidos por él hasta el momento.…”

Comparison of the AN69ST Membrane versus Citrate-Enriched Dialysate on Clotting Events during Hemodialysis without Systemic Anticoagulation

“…It also ameliorates anemia and nutrition and leads to greater hemodynamic stability [17], [12], [20]. Citrate-enriched dialysate, compared to intermittent saline flushes given to patients with a high-risk of bleeding, has also been associated with less thrombus formation in venous air traps [21].…”