title: Acute effect of citrate bath on postdialysis alkalaemia.
abstract: BACKGROUND
  The correction of metabolic acidosis caused by renal failure is achieved by adding bicarbonate during dialysis. In order to avoid the precipitation of calcium carbonate and magnesium carbonate that takes place in the dialysis fluid (DF) when adding bicarbonate, it is necessary to add an acid, usually acetate, which is not free of side effects. Thus, citrate appears as an advantageous alternative to acetate, despite the fact that its acute effects are not accurately known.
  
  
  OBJECTIVE
  To assess the acute effect of a dialysis fluid containing citrate instead of acetate on acid-base balance and calcium-phosphorus metabolism parameters.
  
  
  METHODS
  A prospective crossover study was conducted with twenty-four patients (15 male subjects and 9 female subjects). All patients underwent dialysis with AK-200-Ultra-S monitor with SoftPac® dialysis fluid, made with 3 mmol/L of acetate and SelectBag Citrate®, with 1 mmol/L of citrate and free of acetate. The following were measured before and after dialysis: venous blood gas monitoring, calcium (Ca), ionic calcium (Cai), phosphorus (P) and parathyroid hormone (PTH).
  
  
  RESULTS
  Differences (p<0.05) were found when using the citrate bath (C) compared to acetate (A) in the postdialysis values of: pH, C: 7.43 (0.04) vs. A: 7.47 (0.05); bicarbonate, C: 24.7 (2.7) vs. A: 27.3 (2.1) mmol/L; base excess (BEecf), C: 0.4 (3.1) vs. A: 3.7 (2.4) mmol/L; corrected calcium (Cac), C: 9.8 (0.8) vs. A: 10.1 (0.7) mg/dL; and Cai, C: 1.16 (0.05) vs. A: 1.27 (0.06) mmol/L. No differences were found in either of the parameters measured before dialysis.
  
  
  CONCLUSIONS
  Dialysis with citrate provides better control of postdialysis acid-base balance, decreases/avoids postdialysis alkalaemia, and lowers the increase in Cac and Cai. This finding is of special interest in patients with predisposing factors for arrhythmia and patients with respiratory failure, carbon dioxide retention, calcifications and advanced liver disease.
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España). Electronic address: psequerao@senefro.org.
authors: Patricia De Sequera
authors: Pde S
authors: Ortiz
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Marta Albalate
authors: MA
authors: Ramón
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Rafael
authors: R
authors: Pérez-García
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Elena Corchete
authors: EC
authors: Prats
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Patricia Arribas
authors: PA
authors: Cobo
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Roberto Alcázar
authors: RA
authors: Arroyo
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Maira Ortega
authors: MO
authors: Díaz
authors: Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España).
authors: Marta Puerta
authors: MP
authors: Carretero
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000494:pharmacology; D000137:Acid-Base Imbalance / Q000517:prevention & control; D000138:Acidosis / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D001639:Bicarbonates / Q000008:administration & dosage / Q000494:pharmacology; D001784:Blood Gas Analysis; D002951:Citrates / Q000008:administration & dosage / Q000494:pharmacology*; D018592:Cross-Over Studies; D004573:Electrolytes / Q000097:blood; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000737:chemistry / Q000494:pharmacology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D011446:Prospective Studies
chemical_list: D000085:Acetates; D001639:Bicarbonates; D002951:Citrates; D004573:Electrolytes; D015312:Hemodialysis Solutions
keywords: Acetate; Acetato; Acidosis metabólica; Alcalosis metabólica; Bicarbonate; Bicarbonato; Citrate; Citrato; Hemodiafiltración; Hemodiafiltration; Hemodialysis; Hemodiálisis; Metabolic acidosis; Metabolic alcalosis