Abstract
Background. Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF). Methods. Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate. Results. In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range. Conclusions. Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.
Highlights
There is evidence that in chronic dialysis patients haemodiafiltration (HDF) induces better control of phosphatemia [1, 2] and lower β2-microglobulin (β2-m) blood levels [2, 3] with observed better clinical outcomes [4, 5]
Pilot study we have observed that, in comparison with standard online haemodiafiltration (OL-HDF), OL-HDF performed with a new dialysate substituting citrate for acetate may bring about a lower inflammation, as heralded by the lower pretreatment β2m and CRP serum levels for the same treatment efficiency, and a light “anticoagulant” effect
As for safety, during both citrate techniques, for example, HD and OL-HDF, plasma calcium levels were stable within normal range
Summary
Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF). Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range. Should our promising results be confirmed in a long-term study on a wider population, OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility
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