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Controlled Clinical Trial
. 2009 Sep;4(9):1459-64.
doi: 10.2215/CJN.02590409. Epub 2009 Aug 6.

Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study

Robert J Kossmann  1 , Annette Gonzales, Robin Callan, Suhail Ahmad
Affiliations
Controlled Clinical Trial

Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study

Robert J Kossmann et al. Clin J Am Soc Nephrol. 2009 Sep.

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 beta-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 beta-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.

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Figures

Figure 1.
Figure 1.
The dose of dialysis measured as eKt/Vurea (6 mo average values, n = 142).
Figure 2.
Figure 2.
Mean predialysis blood aluminum levels with regular dialysate and CD (n = 142).
Figure 3.
Figure 3.
The dose of dialysis as eKt/Vurea in low achieved dose patients at baseline (regular dialysate use). Values are during regular dialysate and CD uses and are averages ± SEM (n = 19).
Figure 4.
Figure 4.
Dialysis dose as eKt/Vurea in two groups of patients: those continuing on CD (solid line) for additional 7 mo (n = 69) and those switched back to regular dialysate (dashed line, n = 73). Values are mean ± SD.
See this image and copyright information in PMC

Comment in

  • Dialysate ... Ho-hum!
    Golper TA, Ward RA. Golper TA, et al. Clin J Am Soc Nephrol. 2009 Sep;4(9):1403-4. doi: 10.2215/CJN.04940709. Epub 2009 Aug 20. Clin J Am Soc Nephrol. 2009. PMID: 19696215 No abstract available.

References

    1. Ahmad S, Callan R, Cole JJ, Blagg CR: Increased dialyzer reuse with citrate bicarbonate dialysate. Hemodial Int 9: 264–267, 2005 - PubMed
    1. Pawlak K, Naumnik B, Brzosko S, Pawlak D, Mysilieiec M: Oxidative stress—A link between endothelial injury, coagulation activation, and atherosclerosis in haemodialysis patients. Am J Nephrol 24: 154–161, 2004 - PubMed
    1. Ahmad S: Anticoagulation. In: Manual of Clinical Dialysis, 2nd ed., edited by Ahmad S.New York, Springer, 2009: 29–36
    1. Ahmad S, Callan R, Cole JJ, Blagg CR: Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis 35: 493–499, 2000 - PubMed
    1. Gotch FA, Keen M: Kinetic modeling in hemodialysis. In: Clinical Dialysis, 4th ed., edited by Nissenson AR, Fine RA.New York, McGraw Hill, 2005: 153–203

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