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Conversion from acetate dialysate to citrate dialysate in a central delivery system for maintenance hemodialysis

Eun Ji Park1, Su Woong Jung1, Da Rae Kim2

  • 1Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.

Kidney Research and Clinical Practice
|February 14, 2019
PubMed

Insights

Citrate dialysate (CD) requires less heparin and stabilizes acid-base status in hemodialysis compared to acetate dialysate (AD). This study evaluated 75 patients using central delivery systems, finding significant reductions in heparin demand and improved clinical parameters with CD.

Area of Science:

  • Nephrology
  • Biochemistry
  • Medical Technology

Background:

  • Hemodialysis utilizes dialysate solutions to manage waste products and electrolytes.
  • Acetate dialysate (AD) is a standard solution, while citrate dialysate (CD) offers potential benefits.
  • Central delivery systems (CDS) are used for efficient dialysate administration.

Purpose of the Study:

  • To compare the efficacy of citrate dialysate (CD) versus acetate dialysate (AD) in hemodialysis delivered via a central delivery system (CDS).
  • To assess the impact of CD and AD on heparin requirements and key clinical parameters.

Main Methods:

  • A retrospective study involving 75 maintenance hemodialysis patients using CDS.
  • Patients were treated with AD for six months, followed by CD for six months.
  • Heparin dosage, hsCRP, CaxP, iPTH, and URR were measured at the end of each period.

Main Results:

  • Citrate dialysate (CD) significantly reduced heparin demand (1,129 ± 1,033 IU/session with AD vs. 787 ± 755 IU/session with CD, P < 0.001).
  • CD use led to a more stable acid-base status, indicated by increased pre-dialysis CO2.
  • CD also resulted in significant decreases in intact parathyroid hormone (iPTH) and calcium-phosphate product (CaxP).

Conclusions:

  • Citrate dialysate (CD) is associated with lower heparin requirements in hemodialysis patients using central delivery systems (CDS).
  • CD promotes a more stable acid-base balance and improves key biochemical markers like iPTH and CaxP compared to AD.
Abstract

Keywords:
AcetatesCitric acidHemodialysisHeparin

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