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Controlled Clinical Trial
. 2013 Jan 18:14:18.
doi: 10.1186/1471-2369-14-18.

Acetate free citrate-containing dialysate increase intact-PTH and BAP levels in the patients with low intact-PTH

Takahiro Kuragano  1 , Minoru Furuta, Mana Yahiro, Aritoshi Kida, Yoshinaga Otaki, Yukiko Hasuike, Akihide Matsumoto, Takeshi Nakanishi
Affiliations
Controlled Clinical Trial

Acetate free citrate-containing dialysate increase intact-PTH and BAP levels in the patients with low intact-PTH

Takahiro Kuragano et al. BMC Nephrol. .

Abstract

Background: Recently, acetate-free citrate containing dialysate (A(-)D) was developed. We have already reported about the significant effect of A(-)D on metabolic acidosis, anemia, and malnutrition in maintenance hemodialysis (MHD) patients. In this study, we compared the effect of A(-)D and acetate containing dialysate (A(+)D) on serum calcium and intact-parathyroid hormone (int-PTH) levels.

Method: Single session study: Seventeen patients were treated with A(+)D in one session and also treated with A(-)D in another session. Serum levels of pH, HCO3-, total (t)-calcium, ionized (i)-calcium, and int-PTH were evaluated at the beginning and the end of each session. Cross over study: A total of 29 patients with MHD were treated with A(+)D for 4 months, switched to A(-)D for next 4 months, and returned to A(+)D for the final 4 months.

Results: In single session study, serum i-calcium and t-calcium levels significantly increased, and int-PTH levels decreased after HD with A(+)D, whereas HD with A(-)D did not affect iCa and int-PTH. In cross over study, if all patients were analyzed, there was no significant difference in serum int-PTH or bone alkaline phosphatase (BAP) levels during each study period. In contrast, in the patients with low int-PTH (<60 pg/mL), serum levels of int-PTH and BAP were significantly increased during the A(-)D, without significant changes in serum t-calcium or i-calcium levels.

Conclusion: A(-)D containing citrate could affect calcium and PTH levels, and, in 4 month period of crossover study, increased int-PTH levels pararelled with increasing BAP levels, exclusively in MHD patients with low int-PTH levels.

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Figures

Figure 1
Figure 1
Changes in pH and HCO3- after HD with A(−) and A(+)D in a single session.
Figure 2
Figure 2
Changes in i-calcium, t-calcium, and int-PTH levels after HD with A(−)D and A(+)D in a single session.
Figure 3
Figure 3
Changes in HCO3- levels in all patients, patients with HCO3- ≥ 20 mEq/L and patients with HCO3- < 20 mEq/L in the cross-over study. Error bars are standard deviations. *P < 0.05.
Figure 4
Figure 4
Changes in pre-dialysis t-calcium and i-calcium levels in the patients with int-PTH ≥ 180 pg/mL (A), 60–180 pg/mL (B), and int-PTH < 60 pg/mL (C) in the cross-over study.
Figure 5
Figure 5
Changes in pre-dialysis int-PTH and BAP levels in the patients with int-PTH ≥ 180 pg/mL (A), 60–180 pg/mL (B), and int-PTH < 60 pg/mL (C) during the study period. int-PTH: intact parathyroid hormone; BAP: bone-specific alkaline phosphatase. Error bars are standard deviations. *P < 0.05.
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References

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