title: Post-dilution on line haemodiafiltration with citrate dialysate: first clinical experience in chronic dialysis patients.
abstract: BACKGROUND
  Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF).
  
  
  METHODS
  Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate.
  
  
  RESULTS
  In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β 2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range.
  
  
  CONCLUSIONS
  Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.
authors.affiliation: Nephrology and Dialysis Unit, Versilia Hospital, 55034 Lido Camaiore (Lucca), Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.affiliation: Nephrology and Dialysis Unit, Parma Hospital, 43100 Parma, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
authors.affiliation: Nephrology and Dialysis Unit, Lucca Hospital, 55100 Lucca, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosati
authors.affiliation: Nephrology and Dialysis Unit, SM Annunziata Hospital, 50012 Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fanelli
authors.affiliation: Nephrology and Dialysis Unit, Versilia Hospital, 55034 Lido Camaiore (Lucca), Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Bernabini
authors.affiliation: Nephrology and Dialysis Unit, Versilia Hospital, 55034 Lido Camaiore (Lucca), Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Scatena
authors.affiliation: Nephrology and Dialysis Unit, SM Annunziata Hospital, 50012 Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pizzarelli
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D019343:Citric Acid / Q000008:administration & dosage*; D015314:Dialysis Solutions / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D015314:Dialysis Solutions; D019343:Citric Acid; D017693:Sodium Bicarbonate