Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study

Abstract

Background and objectives: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect. This study examines the effect of CD on dialysis efficiency, measured as eKt/Vurea, and predialysis concentrations of BUN, creatinine, phosphate, and beta-2 microglobulin in chronic dialysis units.

Design, settings, participants, & measurements: Three outpatient chronic hemodialysis units with 142 patients were switched to CD for 6 mo. Using each patient's prior 6 mo on regular bicarbonate dialysate acidified by acetate (AD) as control, eKt/Vurea was compared with that of CD. Follow-up data for 7 mo after the study were collected from about one-half of the participants remaining on CD and the others returned to AD.

Results: eKt/Vurea, increased (P < 0.0001) from pre-CD value of 1.51 +/- 0.01 to 1.57 +/- 0.01 with CD. During CD use beta-2 microglobulin levels declined (P = 0.0001) from 28.1 +/- 10.0 to 25.9 +/- 10.0. Similarly, the concentrations of BUN, creatinine, and phosphate also decreased on CD (P < 0.008). In the poststudy period, eKt/Vurea for the patients staying on CD remained unchanged at 1.60 +/- 0.17 versus 1.59 +/- 0.18 (P = NS), whereas in those returning to AD the eKt/Vurea decreased from 1.55 +/- 0.20 to 1.52 +/- 0.17 (P < 0.0001).

Conclusions: Data suggest that CD use is associated with increased solute removal.

Figures

Figure 1.

The dose of dialysis measured as eKt/Vurea (6 mo average values, n = 142).

Figure 2.

Mean predialysis blood aluminum levels with regular dialysate and CD (n = 142).

Figure 3.

The dose of dialysis as eKt/Vurea in low achieved dose patients at baseline (regular dialysate use). Values are during regular dialysate and CD uses and are averages ± SEM (n = 19).

Figure 4.

Dialysis dose as eKt/Vurea in two groups of patients: those continuing on CD (solid line) for additional 7 mo (n = 69) and those switched back to regular dialysate (dashed line, n = 73). Values are mean ± SD.