title: [Technological advances and micro-inflammation in dialysis patients].
abstract: As currently performed, on line hemodiafiltration reduces, but does not normalize, the micro-inflammation of uremic patients. Recent technological advances make it possible to further reduce the inflammation connected to the dialysis treatment.  Short bacterial DNA fragments are pro-inflammatory and can be detected in the dialysis fluids. However, their determination is not currently within normal controls of the quality of the dialysate. The scenario may change once the analysis of these fragments yields reliable, inexpensive, quick and easy to evaluate the results. At variance with standard bicarbonate dialysate, Citrate dialysate induces far less inflammation both for the well-known anti-inflammatory effect of such buffer and also because it is completely acetate free, e.g. a definitely pro-inflammatory buffer. However, the extensive use of citrate dialysate in chronic dialysis is prevented because of concerns about its potential calcium lowering effect. In our view, high convective exchange on line hemodiafiltration performed with dialysate, whose sterility and a-pirogenicity is guaranteed by increasingly sophisticated controls and with citrate buffer whose safety is certified, can serve as the gold standard of dialysis treatments in future.
authors: Giuseppe
authors: G
authors: Ferro
authors: Fiammetta
authors: F
authors: Ravaglia
authors: Elisa
authors: E
authors: Ferrari
authors: Elena
authors: E
authors: Romoli
authors: Stefano
authors: S
authors: Michelassi
authors: David
authors: D
authors: Caiani
authors: Francesco
authors: F
authors: Pizzarelli
mesh_terms: D019343:Citric Acid; D015314:Dialysis Solutions; D017583:Hemodiafiltration; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D014511:Uremia / Q000150:complications
chemical_list: D015314:Dialysis Solutions; D019343:Citric Acid