Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes

BMC Nephrol. 2009 Mar 5;10:7. doi: 10.1186/1471-2369-10-7.

Abstract

Background: A concentrate for bicarbonate haemodialysis acidified with citrate instead of acetate has been marketed in recent years. The small amount of citrate used (one-fifth of the concentration adopted in regional anticoagulation) protects against intradialyser clotting while minimally affecting the calcium concentration. The aim of this study was to compare the impact of citrate- and acetate-based dialysates on systemic haemodynamics, coagulation, acid-base status, calcium balance and dialysis efficiency.

Methods: In 25 patients who underwent a total of 375 dialysis sessions, an acetate dialysate (A) was compared with a citrate dialysate with (C+) or without (C) calcium supplementation (0.25 mmol/L) in a randomised single-blind cross-over study. Systemic haemodynamics were evaluated using pulse-wave analysis. Coagulation, acid-base status, calcium balance and dialysis efficiency were assessed using standard biochemical markers.

Results: Patients receiving the citrate dialysate had significantly lower systolic blood pressure (BP) (-4.3 mmHg, p < 0.01) and peripheral resistances (PR) (-51 dyne.sec.cm-5, p < 0.001) while stroke volume was not increased. In hypertensive patients there was a substantial reduction in BP (-7.8 mmHg, p < 0.01). With the C+ dialysate the BP gap was less pronounced but the reduction in PR was even greater (-226 dyne.sec.cm-5, p < 0.001). Analyses of the fluctuations in PR and of subjective tolerance suggested improved haemodynamic stability with the citrate dialysate. Furthermore, an increase in pre-dialysis bicarbonate and a decrease in pre-dialysis BUN, post-dialysis phosphate and ionised calcium were noted. Systemic coagulation activation was not influenced by citrate.

Conclusion: The positive impact on dialysis efficiency, acid-base status and haemodynamics, as well as the subjective tolerance, together indicate that citrate dialysate can significantly contribute to improving haemodialysis in selected patients.

Trial registration: ClinicalTrials.gov NCT00718289.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / administration & dosage
  • Acetates / pharmacology*
  • Acid-Base Equilibrium / drug effects*
  • Aged
  • Aged, 80 and over
  • Bicarbonates / administration & dosage
  • Blood Coagulation / drug effects*
  • Blood Urea Nitrogen
  • Calcium / administration & dosage
  • Calcium / blood
  • Calcium / pharmacology
  • Citric Acid / administration & dosage
  • Citric Acid / pharmacology*
  • Cross-Over Studies
  • Electrolytes / blood*
  • Female
  • Hemodialysis Solutions / pharmacology*
  • Hemodynamics / drug effects*
  • Humans
  • Male
  • Middle Aged
  • Phosphates / blood
  • Renal Dialysis / methods*
  • Single-Blind Method

Substances

  • Acetates
  • Bicarbonates
  • Electrolytes
  • Hemodialysis Solutions
  • Phosphates
  • Citric Acid
  • Calcium

Associated data

  • ClinicalTrials.gov/NCT00718289