Abstract
Citrate dialysate has been developed for few years to replace acetate and HCl concentrates. In Online Postdilution Hemodiafiltration (OL-POST-HDF), several issues are remaining concerning the possibility of stopping anticoagulation during sessions and the side effects of citrate solutions on calcium metabolism. This 1-year monocentric retrospective study included all patients exposed to citrate in OL-POST-HDF with nadroparin decrease for more than one month. Clotting events, serum calcium, PTH, hemoglobin, CRP, depuration parameters, and treatments administrated were recorded for analysis. 27 patients experienced nadroparin decrease and 5 did not receive nadroparin at the end of the study. Nadroparin decrease and withdrawal were both associated with more clotting events whereas the use of vitamin K antagonists was protective. No significant metabolic side effects were observed. Citrate dialysate does not allow anticoagulation discontinuation or decrease but has no significant side effects on mineral bone metabolism or erythropoiesis.
Highlights
Acetate is known to provide side effects such as malaise, perdialytic hypotension, cramps, or lipid and mineral bone metabolism disorders [1,2,3] resulting in a worse survival [4]
It results in a better clinical tolerance of the dialysis sessions [11]
This is a retrospective and monocentric study conducted on chronic and stable dialyzed patients who were exposed to citrate-containing dialysate from the 1st of May 2013 to the 30th of April 2014 in our center
Summary
Acetate is known to provide side effects such as malaise, perdialytic hypotension, cramps, or lipid and mineral bone metabolism disorders [1,2,3] resulting in a worse survival [4]. The double-edged property of citrate is its ability to chelate ionized calcium generating low calcium concentration in the dialyser during dialysis session and in the whole blood during and after dialysis time. Citrate could be beneficial by permitting less or no heparin use to avoid circuit clotting but it could have negative impact of mineral bone metabolism by inducing low serum calcium. Both concerns are discussed and remain uncertain
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