Prospective randomized multicenter study to demonstrate the benefits of haemodialysis without acetate (with citrate): ABC-treat Study. Acute effect of citrate

García, Rafael Pérez; Núñez, Manuel Molina; González, Rosa Inés Muñoz; Mérida, Eva; Camba, M; Blázquez, Luis Alberto; Alcaide, Maria Paz; Echarri, Rocio; Sequera, Patricia de; Fernández, Gracia Álvarez; Gallardo, I.; Martínez, E. Hernández; Otero, A.; Heras, Marta Sánchez; Arriba, G. de; Sacaluga, Luis Gil; Cirugeda, A.; Barrio, V.

doi:10.1016/j.nefroe.2019.02.006

Cited by 5 publications

(11 citation statements)

References 29 publications

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“…Therefore, experimental results must be viewed with caution and conclusions not inappropriately extrapolated. Secondly, our results might have been affected by other components in DFs, such as some electrolytes present in small concentrations [30]. Therefore, further preclinical and clinical studies will be required to validate our findings.…”

Section: Discussionmentioning

confidence: 88%

“…Low Mg levels are associated with CVD and high mortality in dialysis patients [3,21,24,46]. Serum Mg in HD patients is affected by the dialysate Mg concentration, which is low (0.5 mM) as standard [23,28,46], and may induce a post-dialytic hypomagnesemia and undesirable hemodynamic effects, such as hypotension, arrhythmia, and calcification) [23,30,46,47]. Furthermore, due to antiinflammatory and antioxidant properties of Mg, hypomagnesemia has also been associated with increased oxidative-inflammatory stress [36,48].…”

Section: Discussionmentioning

confidence: 99%

“…After incubation with IS, cells were incubated for 30 min (37 • C) with DCF-DA (1 mM). Fluorescence was recorded with excitation/emission at 485-535 nm at different times (30,60,90,120,150, and 180 min) after the addition of DCF-DA. The results were expressed as "relative units of fluorescence" (URF) and as a percentage (%) of corresponding basal value without IS.…”

Section: Quantification Of Reactive Oxygen Species Levelsmentioning

confidence: 99%

“…Each point represents the mean ± standard deviation (SD) of 8-10 independent experiments. ROS were measured at different times (30,60,90,120,150, and 180 min), and each value is the mean of duplicate assays. * p < 0.05 and ** p < 0.01 vs. the value in the basal conditions; Figure S2: Intracellular reactive oxygen species (ROS) production in (A) basal conditions (control) and (B) in response of indoxyl sulfate (IS; 256 µg/mL) in human THP-1 monocytes cultured in Hank's medium (control solution) with standard Mg (0.5 mM, control) or with high Mg concentrations (1, 1.25, and 2 mM).…”

Section: Supplementary Materialsmentioning

confidence: 99%

“…However, the optimal Mg concentration in the dialysate has not yet been determined [25,29]. A recent multicenter, randomized, and prospective study suggests the use of citrate dialysates with a higher Mg concentration than the usual (0.5 mM) [30].…”

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confidence: 99%

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Increasing the Magnesium Concentration in Various Dialysate Solutions Differentially Modulates Oxidative Stress in a Human Monocyte Cell Line

et al. 2020

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es (M.A.) † These authors share senior authorship.Abstract: Oxidative stress is exacerbated in hemodialysis patients by several factors, including the uremic environment and the use of dialysis fluids (DFs). Since magnesium (Mg) plays a key role in modulating immune function and in reducing oxidative stress, we aimed to evaluate whether increasing the Mg concentration in different DFs could protect against oxidative stress in immunocompetent cells in vitro. Effect of ADF (acetate 3 mM), CDF (citrate 1 mM), and ACDF (citrate 0.8 mM + acetate 0.3 mM) dialysates with Mg at standard (0.5 mM) or higher (1, 1.25, and 2 mM) concentrations were assessed in THP-1 monocyte cultures. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels were quantified under basal and uremic conditions (indoxyl sulfate (IS) treatment). Under uremic conditions, the three DFs with 0.5 mM Mg promoted higher ROS production and lipid damage than the control solution. However, CDF and ACDF induced lower levels of ROS and MDA, compared to that induced by ADF. High Mg concentration (1.25 and/or 2 mM) in CDF and ACDF protected against oxidative stress, indicated by reduced ROS and MDA levels compared to respective DFs with standard concentration of Mg. Increasing Mg concentrations in ADF promoted high ROS production and MDA content. Thus, an increase in Mg content in DFs has differential effects on the oxidative stress in IS-treated THP-1 cells depending on the dialysate used. renal function and the prevalence of cardiovascular events through altered leukocyte activation and intensified oxidative stress [3][4][5][6][7].Classically, UTs are divided into three categories: low-molecular-weight water-soluble solutes (<500 Da), middle-molecular-weight solutes (>500 Da), and protein-bound solutes [8]. These uremic toxins, represented by IS, is extremely toxic and difficult to eliminate by conventional dialysis; consequently, high IS levels may trigger oxidative-inflammatory stress, playing a key pathophysiologic role in CKD. In fact, several studies have confirmed that the occurrence of CVD induced by CKD is closely related to the IS accumulation [3].Uremia promotes a state of enhanced oxidative stress, which is the result of pro-oxidant molecules, such as reactive oxygen species (ROS), overwhelming the antioxidant defense mechanisms [9]. An increase in oxidative stress occurs during the dialysis session owing to the loss of antioxidants (e.g., uric acid, etc.) and the activation of leukocytes, which trigger both inflammatory compounds and ROS production, contributing to oxidative damage of biomolecules (e.g., lipid peroxidation, DNA damage, etc.) [3,[9][10][11][12].Clinical and experimental evidence demonstrates that several factors inherent to the dialysis procedure itself, such as dialysis modality, iron administration, biocompatibility, and types of dialyzer membrane and dialysates, can play a key role promoting chronic inflammation and oxidative stress in HD patients [9][10][11][12]. Bio-incompatibility during HD induces leukocyte activation...

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Quantification Of Reactive Oxygen Species Levelsmentioning

confidence: 99%

Section: Supplementary Materialsmentioning

confidence: 99%

mentioning

confidence: 99%

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Increasing the Magnesium Concentration in Various Dialysate Solutions Differentially Modulates Oxidative Stress in a Human Monocyte Cell Line

et al. 2020

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Multi‐response optimization of shrinkage, clamp force, and part weight in simulated injection molding process of a dialysis micro‐filter

Heidari

Bappoo

Kelsey

et al. 2021

J of Applied Polymer Sci

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Air traps play a critical role in controlling air bubbles and clots in hemodialysis systems. The quality of the micro‐filter, an injection molded part inside the air trap, influence the potential risk of passing emboli to the patient, which can result in serious complications. The aim of this work is optimizing the simulated injection molding process of a dialysis micro‐filter based on minimizing the shrinkage, part weight, and clamping force to maximize the part quality. First, micro‐computed tomography is used to diagnose defects of a typical micro‐filter due to the molding process. Next, the injection molding of micro‐filter is simulated via Autodesk Moldflow Adviser (AMA) to obtain the responses, and the interactions of the process factors are then determined by central composite design (CCD). The injection time is the most significant influence on the responses. Multi‐response optimization results for the equal weights of the responses show the minimum shrinkage, part weight, clamp force of 8.84%, 0.744 g and 0.625 tonne, respectively, with composite desirability of 0.61. Finally, the predicted values using regression models are successfully validated via AMA, offering the optimal process settings to produce high quality dialysis micro‐filter to reduce the risk of passing emboli to patients.

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Improvements in Inflammation and Calcium Balance of Citrate versus Acetate as Dialysate Buffer in Maintenance Hemodialysis: A Unicentric, Cross-Over, Prospective Study

et al. 2021

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Introduction: The composition of the dialysate is a crucial feature in the dialysis treatment. Two of its most debated elements are the optimal calcium concentration and the use of acetate as a buffer. Moreover, among the different alternatives to achieve acetate-free dialysis, the use of citrate is postulated as the most suitable option. The objective of this study is to identify the potential beneficial effects of citrate when compared to acetate dialysate (AD) both in short-term effects (especially regarding intradialytic calcium balance and cardiac damage biomarkers) and in medium-term ones with CKD-mineral and bone disorder (CKD-MBD) and inflammatory biomarkers measured after twelve sessions performed with each dialysate. Methods: This is a unicentric, cross-over, prospective study. Each patient underwent 24 dialysis sessions, 12 with each dialysate buffer. Blood samples were taken in 2 different sessions with each acidifier. They include CKD-MBD and inflammatory biomarkers. The calcium concentration of both dialysates was 1.5 mmol/L, while all other dialysis parameters and patients’ treatment remained unchanged during the study period. Results: When comparing AD and citrate dialysate (CD), there were no differences in pre-dialysis ionized calcium (iCa) (1.11 vs. 1.08 mmol/L) in both groups. However, there was a significant increase in iCa with the use of AD in immediate and 30-min post-dialysis blood samples. In contrast, iCa levels remained stable with the use of citrate. Inflammatory biomarkers were also reduced after the use of CD. Conclusions: The use of citrate provides interesting advantages when compared to acetate. It maintains iCa levels stable during dialysis sessions with a neutral or negative effect on calcium balance, and it improves the chronic inflammatory condition that comes with long-time hemodialysis treatment. These beneficial effects may lead to an improvement in clinical outcomes.

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Prospective randomized multicenter study to demonstrate the benefits of haemodialysis without acetate (with citrate): ABC-treat Study. Acute effect of citrate

Cited by 5 publications

References 29 publications

Increasing the Magnesium Concentration in Various Dialysate Solutions Differentially Modulates Oxidative Stress in a Human Monocyte Cell Line

Increasing the Magnesium Concentration in Various Dialysate Solutions Differentially Modulates Oxidative Stress in a Human Monocyte Cell Line

Multi‐response optimization of shrinkage, clamp force, and part weight in simulated injection molding process of a dialysis micro‐filter

Improvements in Inflammation and Calcium Balance of Citrate versus Acetate as Dialysate Buffer in Maintenance Hemodialysis: A Unicentric, Cross-Over, Prospective Study

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