title: Effects of acetate-free citrate-containing dialysate on metabolic acidosis, anemia, and malnutrition in hemodialysis patients.
abstract: Previously, dialysate contained small amounts of acetate as an alkaline buffer. Recently, acetate-free dialysate (A[-]D) has been available. We evaluated the clinical effect of A(-)D over acetate-containing dialysate (A(+)D) on acid-base balance, anemia, and nutritional status in maintenance hemodialysis (MHD) patients. Twenty-nine patients on MHD were treated with A(+)D for 4 months (first A(+)D), switched to A(-)D for 4 months, and returned to A(+)D for the next 4-month period (second A(+)D). Metabolic acidosis: Serum bicarbonate (HCO3(-) ) levels did not change in patients with normal HCO3(-)  levels (≥20 mEq/L) throughout the study. Meanwhile, in patients with initially low HCO3(-)  levels, it was significantly increased during the A(-)D period only. Anemia: In patients with target hemoglobin (Hb) ≥10 g/dL, Hb levels were maintained during the study period, even if the dose of erythropoiesis-stimulating agents (ESAs) decreased. In patients with low Hb levels, it was significantly increased in the A(-)D period without increasing ESA or iron doses. Nutritional Condition: In patients with normal albumin levels (≥3.8 g/dL), albumin did not change throughout the study period. However, in patients with lower albumin levels, it was significantly increased during the A(-)D period. These improvements in metabolic acidosis, anemia, and nutrition in the A(-)D period completely dissipated during the second A(+)D period. Hemodialysis (HD) with A(-)D may improve a patient's clinical status with intractable metabolic acidosis, hyporesponsiveness to ESA, and malnutrition that were not normalized in HD with A(+)D.
authors.affiliation: Department of Internal Medicine Division of Kidney and Dialysis, Hyogo College of Medicine Seishoukai Aoi Hospital, Nishinomiya, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan. kuragano@hyo-med.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kuragano
authors.forename: Aritoshi
authors.initials: A
authors.lastname: Kida
authors.forename: Minoru
authors.initials: M
authors.lastname: Furuta
authors.forename: Mana
authors.initials: M
authors.lastname: Yahiro
authors.forename: Rie
authors.initials: R
authors.lastname: Kitamura
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Otaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Akihide
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakanishi
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000097:blood / Q000628:therapy*; D000368:Aged; D000740:Anemia / Q000097:blood / Q000628:therapy*; D019343:Citric Acid / Q000627:therapeutic use*; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000628:therapy*; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods
chemical_list: D000085:Acetates; D015314:Dialysis Solutions; D019343:Citric Acid