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

Eun Ji Park; Su Woong Jung; Da Rae Kim; Jin Sug Kim; Tae Won Lee; Chun Gyoo Ihm; Kyung Hwan Jeong

doi:10.23876/j.krcp.18.0045

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

Kidney Res Clin Pract. 2019 Mar 31;38(1):100-107. doi: 10.23876/j.krcp.18.0045.

Authors

Eun Ji Park¹, Su Woong Jung¹, Da Rae Kim², Jin Sug Kim¹, Tae Won Lee¹, Chun Gyoo Ihm¹, Kyung Hwan Jeong¹

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
² Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.

Abstract

Background: The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters.

Methods: We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period.

Results: Patients were 60.5 ± 14.7 years old, of whom 62.7% were male. Patients required less heparin when receiving CD (AD period: 1,129 ± 1,033 IU/session vs. CD period: 787 ± 755 IU/session, P < 0.001). After the CD period (Δ_CD), pre-dialysis total CO₂ increased to 1.21 ± 2.80 mmol/L, compared to -2.44 ± 2.96 mmol/L (P < 0.001) after the AD period (Δ_AD). After the CD period, concentrations of iPTH (Δ_AD: 73.04 ± 216.34 pg/mL vs. Δ_CD: -106.66 ± 251.79 pg/mL, P < 0.001) and CaxP (Δ_AD: 4.32 ± 16.63 mg²/dL² vs. Δ_CD: -4.67 ± 15.27 mg²/dL², P = 0.015) decreased. While hsCRP levels decreased after the CD period (Δ_AD: 0.07 ± 4.09 mg/L vs. Δ_CD: -0.75 ± 4.56 mg/L, P = 0.705), the change was statistically insignificant. URR remained above clinical guideline of 65% after both periods (Δ_AD: 72.33 ± 6.92% vs. Δ_CD period: 69.20 ± 4.49%, P = 0.046).

Conclusion: Our study confirmed that the use of CD in CDS required lower heparin doses compared to the use of AD. The use of CD also provided a more stable acid-base status.

Keywords: Acetates; Citric acid; Hemodialysis; Heparin.