On-line haemodiafiltration with and without acetate

Abstract

Background. In patients on on-line convective treatments, given the considerable quantity of dialysis fluid re-infused, the small amount of acetate present in bicarbonate dialysis fluid as a pH stabilizing factor may allow a significant transfer of that anion to the patient, possibly inducing cytokine activation. Methods. To verify this hypothesis, we performed on-line haemodiafiltration (OL-HDF) with (3 mmol/l) and without acetate in dialysis fluid in a cross-over randomized order on 12 prevalent patients. Results. In comparison with the pre-treatment values, plasma acetate levels were unchanged during and after acetate-free OL-HDF, while they were 5-6 times higher in the course of OL-HDF containing acetate in dialysis fluid; plasma acetate levels returned to basal values 2 h after the end of the procedure. The total increase of bases in the patient attributable to acetate was 36%.Plasma bicarbonate values at the end of treatment were significantly lower in treatments without acetate, as compared to those with acetate. Interleukin-6 plasma levels were super-imposable at the beginning and in the course of the two methods compared, but there was a tendency towards a greater increase at an interval of 2 h following OL-HDF with acetate. Conclusions. Our preliminary results confirm the assumption that body gain of acetate is particularly high in convective treatments, while acetate-free OL-HDF slows down acetate burden. Clinical advantages due to these effects should be evaluated in properly designed prospective studies.

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

“…However, although the acetate level is typically low, the small amount that the bicarbonate dialysis fluid contains can induce, by itself, an inflammatory stimulus caused by the high volume reinfused to the patient [12]. …”

Hemodiafiltration with Endogenous Reinfusion with and without Acetate-Free Dialysis Solutions: Effect on ESA Requirement

“…Moreover, components such as acetate, small quantities of which (approx. 3–5 m M ) are normally present as stabilizing agents in DS and RS produced on-line, may negatively affect erythropoiesis, triggering the inflammatory cascade during the dialysis session [14,15,16,17,18,19]. …”

Hypersensitivity reactions to acetate in the bicarbonate dialysate in a patient undergoing pre-dilution online hemodiafiltration

“…A challenge test using a commercially available acetic acid showed that serum acetate level was increased to 800 lM during an attack of asthma due to acetate ingestion [1]. In this case, the bicarbonate dialysate contained almost 3-time higher amount of acetate (9.1 mM) compared to the previous ones [5,6]. It is, therefore, likely that a greater load of acetate to the patient during pre-dilution OL-HDF may trigger hypersensitivity reactions to acetate in this case.…”

“…It is reported that pre-dilution OL-HDF with 40 L of filtered bicarbonate dialysate containing 3 mM of acetate resulted in an increase of plasma acetate level by about 10-fold (from 25 ± 2 to 316 ± 14 lM), whereas the plasma level of acetate remain in the normal range (1-100 lM) (from 33 ± 5 to 71 ± 15 lM) when using acetate-free dialysate [6]. A challenge test using a commercially available acetic acid showed that serum acetate level was increased to 800 lM during an attack of asthma due to acetate ingestion [1].…”