Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 31;38(1):100-107.
doi: 10.23876/j.krcp.18.0045.

Conversion from acetate dialysate to citrate dialysate in a central delivery system for maintenance hemodialysis patients

Eun Ji Park  1 , Su Woong Jung  1 , Da Rae Kim  2 , Jin Sug Kim  1 , Tae Won Lee  1 , Chun Gyoo Ihm  1 , Kyung Hwan Jeong  1
Affiliations

Conversion from acetate dialysate to citrate dialysate in a central delivery system for maintenance hemodialysis patients

Eun Ji Park et al. Kidney Res Clin Pract. .

Abstract

Background: The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters.

Methods: We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period.

Results: Patients were 60.5 ± 14.7 years old, of whom 62.7% were male. Patients required less heparin when receiving CD (AD period: 1,129 ± 1,033 IU/session vs. CD period: 787 ± 755 IU/session, P < 0.001). After the CD period (ΔCD), pre-dialysis total CO2 increased to 1.21 ± 2.80 mmol/L, compared to -2.44 ± 2.96 mmol/L (P < 0.001) after the AD period (ΔAD). After the CD period, concentrations of iPTH (ΔAD: 73.04 ± 216.34 pg/mL vs. ΔCD: -106.66 ± 251.79 pg/mL, P < 0.001) and CaxP (ΔAD: 4.32 ± 16.63 mg2/dL2 vs. ΔCD: -4.67 ± 15.27 mg2/dL2, P = 0.015) decreased. While hsCRP levels decreased after the CD period (ΔAD: 0.07 ± 4.09 mg/L vs. ΔCD: -0.75 ± 4.56 mg/L, P = 0.705), the change was statistically insignificant. URR remained above clinical guideline of 65% after both periods (ΔAD: 72.33 ± 6.92% vs. ΔCD period: 69.20 ± 4.49%, P = 0.046).

Conclusion: Our study confirmed that the use of CD in CDS required lower heparin doses compared to the use of AD. The use of CD also provided a more stable acid-base status.

Keywords: Acetates; Citric acid; Hemodialysis; Heparin.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Flow chart of study design
AD period, a six-month period during which acetate dialysate was used; CD period, a six-month period during which citrate dialysate was used; HD, hemodialysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Todeschini M, Macconi D, Fernández NG, et al. Effect of acetate-free biofiltration and bicarbonate hemodialysis on neutrophil activation. Am J Kidney Dis. 2002;40:783–793. doi: 10.1053/ajkd.2002.35690. - DOI - PubMed
    1. Noris M, Todeschini M, Casiraghi F, et al. Effect of acetate, bicarbonate dialysis, and acetate-free biofiltration on nitric oxide synthesis: implications for dialysis hypotension. Am J Kidney Dis. 1998;32:115–124. doi: 10.1053/ajkd.1998.v32.pm9669432. - DOI - PubMed
    1. Gabutti L, Lucchini B, Marone C, Alberio L, Burnier M. Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes. BMC Nephrol. 2009;10:7. doi: 10.1186/1471-2369-10-7. - DOI - PMC - PubMed
    1. Nilsson B, Ekdahl KN, Mollnes TE, Lambris JD. The role of complement in biomaterial-induced inflammation. Mol Immunol. 2007;44:82–94. doi: 10.1016/j.molimm.2006.06.020. - DOI - PubMed
    1. Dhondt A, Vanholder R, Tielemans C, et al. Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membranes. Nephron. 2000;85:334–342. doi: 10.1159/000045683. - DOI - PubMed