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. 2024 Dec;46(1):2302109.
doi: 10.1080/0886022X.2024.2302109. Epub 2024 Jan 8.

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients

Pasu Nakornchai  1 , Arisara Jitraree  1 , Monpinya Charttong Homjan  1 , Thanachit Laykhram  1 , Thananda Trakarnvanich  1
Affiliations

Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients

Pasu Nakornchai et al. Ren Fail. 2024 Dec.

Abstract

Background: Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes.

Method: Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.

Results: The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase (p < 0.001 in the baseline phase, p = 0.001 in phase 1, and p = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19, p = 0.002). The patient's quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 (p = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.

Conclusion: Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.

Keywords: Adequacy of dialysis; citrate dialysate; clot formation; hemodialysis; online hemodiafiltration; post- dilution; pre-dilution.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Comparison between erythrocyte stimulating agents dose between pre-and post- dilution online hemodiafiltration.
Figure 3.
Figure 3.
Mental component summary (MCS) and physical component summary (PCS) are comparable between pre and post-dilution mode A: Physical component B: Mental component Comparison between erythrocyte stimulating agents between pre- and post- dilution online hemodiafiltration
See this image and copyright information in PMC

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