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


METHODS
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.
Kossmann
Robert J
RJ
Nephrophiles LLC, Santa Fe, New Mexico, USA.
Gonzales
Annette
A
Callan
Robin
R
Ahmad
Suhail
S
D019342:Acetic Acid / Q000627:therapeutic use*; D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use*; D001639:Bicarbonates / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D001806:Blood Urea Nitrogen; D019343:Citric Acid / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D014481:United States; D001613:beta 2-Microglobulin / Q000097:blood
D000925:Anticoagulants; D001639:Bicarbonates; D015415:Biomarkers; D015314:Dialysis Solutions; D010710:Phosphates; D001613:beta 2-Microglobulin; D019343:Citric Acid; D003404:Creatinine; D019342:Acetic Acid