Acetate or bicarbonate for haemodialysis: a randomised, double-blind controlled trial

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis

Background:

• Hemodialysis is a critical treatment for end-stage renal disease.
• Dialysis fluid composition, particularly the buffer, can influence patient outcomes.
• Acetate and bicarbonate are common buffers used in hemodialysis fluids.

Purpose of the Study:

• To compare the clinical efficacy and patient tolerance of bicarbonate-based versus acetate-based dialysis fluids.
• To evaluate the impact of different dialysis fluid buffers on adverse reactions, food consumption, blood chemistry, and anthropometry in chronic hemodialysis patients.

Main Methods:

• Prospective, randomized, double-blind controlled trial.
• Comparison of acetate- and bicarbonate-based dialysis fluids over two 3-month periods.
• Inclusion of 16 stable, chronic hemodialysis patients with fixed sodium content (140 mmol/l).

Main Results:

• Identical patient complaints and adverse reactions were reported for both dialysis fluid types.
• No significant differences in blood chemistry were observed, except for less pronounced metabolic acidosis with bicarbonate dialysis.
• A slight, non-significant increase in food consumption and nutritional status was noted during bicarbonate dialysis.

Conclusions:

• Bicarbonate-based hemodialysis fluids do not offer significant advantages over acetate-based fluids for stable, chronic hemodialysis patients.
• Clinical outcomes, including adverse reactions and nutritional status, are comparable between the two buffer types.
• Further research may be needed to identify specific patient subgroups that could benefit from bicarbonate-based dialysis.