title: Effects of citrate dialysate in chronic dialysis: a multicentre randomized crossover study.
abstract: Although citrate dialysate (CiDi) is regarded to be safe, dialysis modalities using higher dialysate volumes, like haemodiafiltration (HDF), may expose patients to higher citrate load and thus increase the risk of complications. We investigated the residual risk of CiDi compared with standard dialysate (StDi) in patients on different dialysis modalities and its effect on dialysis dose.
  
  
  
  In a multicentre randomized crossover study, 92 dialysis patients (HDF post-dilution: n = 44, HDF pre-dilution: n = 26, haemodialysis: n = 25) were treated for 4 weeks with each dialysate (StDi and CiDi). Hypocalcaemia (ionized calcium ≤0.9 mmol/L), alkalosis (pH ≥7.55), post-treatment bicarbonate ≥32 mmol/L, pre-treatment bicarbonate ≥27 mmol/L, intra-dialytic events (IEs) and adverse events (AEs) between dialysis sessions were investigated as primary end points. The secondary objective was dialysis efficacy, i.e. dose and removal ratios of urea, creatinine, phosphate and β-2-microglobulin.
  
  
  
  Post-dialysis overcorrection of bicarbonate (>32 mmol/L) was less frequent with CiDi (P = 0.008). Other predefined calcium and acid-base disturbances did not vary. There was no significant difference in IE. However, more patients developed AEs such as fatigue, muscle spasms or pain using CiDi (StDi: 41 versus CiDi: 55 patients, P = 0.02), particularly in the first 2 weeks of exposure. Dialysis efficacy was comparable with both dialysates.
  
  
  
  It can be confirmed that CiDi is not associated with the development of severe calcium and acid-base disorders, even when dialysis modalities with higher citrate loads are used. However, a refinement of the CiDi composition to minimize AEs is necessary.
authors.affiliation: Department of Nephrology and General Medicine, Städtisches Klinikum Solingen GmbH, Solingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmitz
authors.affiliation: Nephrologische Gemeinschaftspraxis Dialyse und Lipidapherese, Lüdenscheid, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Loke
authors.affiliation: PHV Dialysezentrum, Wetzlar, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fach
authors.affiliation: Märkische Dialysezentren GmbH, Lüdenscheid, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kalb
authors.affiliation: Department of Nephrology and General Medicine, Städtisches Klinikum Solingen GmbH, Solingen, Germany.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Heering
authors.affiliation: Nephrologische Gemeinschaftspraxis Dialyse und Lipidapherese, Lüdenscheid, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Meinke
authors.affiliation: PHV Dialysezentrum, Wetzlar, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rawer
authors.affiliation: Märkische Dialysezentren GmbH, Lüdenscheid, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Galle
authors.affiliation: Clinical Research, Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Justyna
authors.initials: J
authors.lastname: Kozik-Jaromin
mesh_terms: D000328:Adult; D000368:Aged; D065096:Calcium Chelating Agents / Q000494:pharmacology; D019343:Citric Acid / Q000494:pharmacology*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D065096:Calcium Chelating Agents; D015314:Dialysis Solutions; D019343:Citric Acid
keywords: calcium; citrate; citrate dialysate; dialysis; haemodiafiltration