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

Details

Serval ID
serval:BIB_24D625EC4BCC
Type
Article: article from journal or magazin.
Collection
Publications
Title
Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes.
Journal
Bmc Nephrology
Author(s)
Gabutti L., Lucchini B., Marone C., Alberio L., Burnier M.
ISSN
1471-2369 (Electronic)
ISSN-L
1471-2369
Publication state
Published
Issued date
2009
Volume
10
Pages
7
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: epublish
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.
Keywords
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, 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
Pubmed
Open Access
Yes
Create date
24/07/2013 9:27
Last modification date
16/04/2020 5:26
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