Safe Use of Citric Acid-Based Dialysate and Heparin Removal in Postdilution Online Hemodiafiltration

Aniort, Julien; Petitclerc, Thierry; Créput, Caroline

doi:10.1159/000345342

Cited by 25 publications

(30 citation statements)

References 34 publications

(25 reference statements)

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“…Some authors suggest a systemic anticoagulant effect with reduced heparin requirements [1,3,4,24], or local [5,25] requirements in the fibers of the dialyzer as the probable cause of the improvement in dialysis efficiency. For other authors, the main reason would be less precipitation of calcium salts (Gunilla Grundstrm, personal conference, 49th EDTA Congress, Paris, 2013).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…The clotting of the dialyzer was assessed using the corrected visual scale adapted from Aniort et al [6], as seen in Table 1 Residual blood in less than 10% of the fibers 2…”

Section: Data Collectionmentioning

confidence: 99%

The Effect of Citrate on Clot Formation, Dialyzer Reuse, and Anemia in Hemodialysis Patients

Trakarnvanich

Thirathanakul

Sriphueng³

et al. 2018

Blood Purif

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Background: Citrate anticoagulation is increasingly favored for preventing extracorporeal circuit clotting during renal replacement therapy. This study tested the effect of citrate compared with acetate on heparin avoidance and other parameters. Methods: Sixty-one chronic hemodialysis (HD) patients were switched from conventional dialysis fluid (acetate) to citrate dialysis fluid and were treated in 3 phases, each lasting 4 weeks: 50%, 25%, and no heparin. Visual clotting score, erythropoiesis stimulating agent (ESA) dose, and laboratory parameters were measured. Results: Except for 2 episodes of clotting, the same dialyzers were used throughout each citrate phase. The mean visual clotting scores were comparable across study periods. Hemoglobin decreased slightly in phase 2 despite the constant ESA dose. The ionized calcium levels rose after HD in most sessions. No adverse events occurred during citrate dialysis. Conclusion: During citrate dialysis in chronic HD patients, heparin can be completely avoided. The electrolyte levels, the adequacy of dialysis, and hemoglobin can be maintained without significant adverse events.

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“…Citrate has several advantages over acetate, including local anticoagulant properties that allow a decrease or even removal of anticoagulation for HD, lower peripheral resistance and better blood pressure control during the procedure [6,7,8,9,10]. Another advantage is an increased HD efficiency when citrate dialysate is used [5].…”

Section: Introductionmentioning

confidence: 99%

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

Šafránek¹,

Moučka²,

Vávrová³

et al. 2015

Kidney Blood Press Res

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Background/Aims: In recent years, one of technical attempts to improve biocompatibility and tolerability of the hemodialysis procedure is the substitution of acetate in dialysis solution with citrate. The aim of our study was to compare two dialysis solutions: traditional bicarbonate dialysis solution containing acetate (3 mmol/L) (solution A); and (solution C) commercially produced citrate-enriched bicarbonate dialysis solution (0.8 mmol/L citrate). Methods: Patients from a single hemodialysis center (N=126) were included in the study. Both conventional low-flux hemodialysis and on-line hemodiafiltration procedures were studied. Both dialysis solutions contained identical calcium (1.5 mmol/L) and magnesium (0.5 mmol/L) concentrations. Results: Parathyroid hormone (iPTH) concentration decreased during procedures with solution A by 64%. On the contrary, when solution C was used, iPTH concentration increased insignificantly by 4%. For solution A, serum calcium and magnesium increased during procedures in patients with predialysis concentrations lower than 2.33 and 0.76 mmol/L, respectively. In procedures with dialysis solution C these concentrations were significantly lower: 2.19 mmol/L for Ca and 0.68 mmol/L for Mg. Conclusion: Our study clearly shows that the substitution of part of acetate with citrate in dialysis solution significantly influences changes of serum calcium, magnesium and parathyroid hormone concentrations during hemodialysis and hemodiafiltration procedures.

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Safe Use of Citric Acid-Based Dialysate and Heparin Removal in Postdilution Online Hemodiafiltration

Cited by 25 publications

References 34 publications

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

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

The Effect of Citrate on Clot Formation, Dialyzer Reuse, and Anemia in Hemodialysis Patients

Changes of Serum Calcium, Magnesium and Parathyroid Hormone Induced by Hemodialysis with Citrate-Enriched Dialysis Solution

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