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On-line haemodiafiltration with and without acetate
Francesco Pizzarelli1, Tiziano Cerrai, Pietro Dattolo
1Nephrology and Dialysis Unit, SM Annunziata Hospital, Florence, Italy. fpizzarelli@yahoo.com
Summary
Acetate-free on-line haemodiafiltration (OL-HDF) reduces acetate accumulation in patients undergoing convective treatments. This acetate-free approach may mitigate potential cytokine activation associated with acetate infusion during dialysis.
Area of Science:
- Nephrology
- Biochemistry
- Clinical Medicine
Background:
- Convective dialysis treatments involve significant fluid re-infusion.
- Acetate in dialysis fluid, used for pH stabilization, may transfer to patients, potentially activating cytokines.
Purpose of the Study:
- To investigate acetate transfer and its effects during on-line haemodiafiltration (OL-HDF).
- To compare OL-HDF with and without acetate in the dialysis fluid.
Main Methods:
- A cross-over randomized study was conducted on 12 prevalent patients.
- Patients underwent OL-HDF with and without 3 mmol/l acetate in the dialysis fluid.
Main Results:
- Plasma acetate levels increased 5-6 fold with acetate-containing fluid but remained unchanged with acetate-free fluid.
- Acetate contributed to a 36% increase in patient bases; bicarbonate levels were lower in acetate-free treatments.
- Interleukin-6 levels showed a trend towards greater increase 2 hours post-OL-HDF with acetate.
Conclusions:
- Body acetate gain is substantial in convective treatments.
- Acetate-free OL-HDF effectively reduces acetate burden.
- Further prospective studies are needed to confirm clinical benefits.