Increased Efficiency of Hemodialysis with Citrate Dialysate

Abstract

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.

Effects of Citrate Acid Concentrate (Citrasate®) on Heparin N Requirements and Hemodialysis Adequacy: A Multicenter, Prospective Noninferiority Trial

“…Over 94% (211/224) of the subjects in P2 and over 92% (180/195) of the subjects in P3 (CD + 66.7% HN) demonstrated noninferiority of dialyzer clearance (margin greater than –8%) with no increase in dialyzer/dialysis line clotting or postdialysis time to hemostasis. These data confirm earlier reports of improved dialyzer clearance and heparin reduction with the use of CD [2,5,10,11,12]. Heparin use is associated with significant risks including the possibility of bleeding, HIT, and contamination [11,12,13,14].…”

“…CD is FDA-approved [1] and has been demonstrated to be safe and effective [2]. Published reports suggest that CD may improve dialysis adequacy [Kt/V (K = clearance, t = time on dialysis and V = volume of distribution)] [2,5,6], decrease hemodialysis heparin requirements [7,8,9], and increase dialyzer reuse [10], presumably due to nonsystemic anticoagulant effects in the dialyzer. These studies, however, are limited by their small sample size and/or lack of adequate controls.…”

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

“…La diálisis con LDC resulta eficaz para modular la respuesta inflamatoria de nuestros pacientes dando lugar a niveles reducidos de PCR coincidiendo con los resultados de Matsuyama et al 4 , y menores niveles de lipoproteínas de baja densidad (B2MCG) limitando el estrés oxidativo asociado a la diálisis 8 .…”

Citrate Anticoagulation in Hemodialysis

“…The use of dialysate-side citrate anticoagulation (i.e., the use of a citrate-and calciumcontaining dialysate without arterial citrate infusion or venous calcium substitution) has sparked interest recently for its alleged heparin-sparing potential and its safety and ease of use [27][28][29]. At unchanged heparin doses, using citrate-containing dialysate (instead of bicarbonate dialysate acidified with acetate) appears to improve solute removal [30]. Citrate anticoagulation holds great promises for improving the outcomes of hemodialysis patients.…”