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Effects of Citrate Acid Concentrate on Hemodialysis Adequacy, Reuse, and Quality of Life: A Prospective Randomized

S P Nagaraju1, S Kosuru2, R Parthasarathy3

  • 1Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India.

Indian Journal of Nephrology
|August 31, 2018
PubMed

Insights

Citrate dialysate (CD) for hemodialysis improves dialyzer reuse but shows no significant difference in adequacy or quality of life compared to acetate dialysate (AD). CD is a safe alternative for end-stage renal disease patients.

Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Technology

Background:

  • Bicarbonate hemodialysis is a standard treatment for end-stage renal disease (ESRD).
  • Acetate dialysate (AD) is commonly used, but citrate dialysate (CD) has been proposed as an alternative.
  • The comparative benefits of CD versus AD regarding dialysis adequacy, dialyzer reuse, and patient quality of life require further investigation.

Purpose of the Study:

  • To compare the efficacy and safety of citrate dialysate (CD) versus acetate dialysate (AD) in patients undergoing maintenance hemodialysis.
  • To evaluate the impact of CD on hemodialysis adequacy, dialyzer reuse, and quality of life in ESRD patients.
  • To assess secondary outcomes including intradialytic hypotension, acidosis correction, and hypocalcemia.

Main Methods:

  • A 1-year, single-blinded, randomized prospective crossover trial involving 32 stable ESRD patients on twice-weekly hemodialysis.
  • Patients were randomly assigned to receive either CD or AD fluid.
  • Primary outcomes included hemodialysis adequacy (spKt/V, urea reduction ratio), dialyzer reuse, and quality of life. Secondary outcomes assessed intradialytic hypotension, acidosis, and hypocalcemia.

Main Results:

  • A total of 28 patients completed 1456 sessions with CD and 1456 sessions with AD.
  • Citrate dialysate (CD) significantly increased dialyzer reuse (P = 0.02).
  • No significant differences were observed in hemodialysis adequacy (spKt/V, P = 0.840; urea reduction ratio, P = 0.90), quality of life, acidosis correction (pH, P = 0.23; bicarbonate, P = 0.17), or calcium levels (P = 0.16).

Conclusions:

  • Citrate dialysate (CD) is a safe and equally effective alternative to acetate dialysate (AD) for bicarbonate hemodialysis.
  • CD significantly enhances the potential for dialyzer reuse in hemodialysis patients.
  • CD does not provide additional benefits regarding hemodialysis adequacy or overall quality of care compared to AD.

Keywords:
Citrate dialysatedialysis adequacydialyzer reusequality of life

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