Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study.

Autor:	de Sequera P; Departamento de Medicina, Universidad Complutense, Madrid, España; Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: patricia.desequera@salud.madrid.org., Pérez-García R; Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España., Molina M; Servicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, España., Álvarez-Fernández G; Servicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, España., Muñoz-González RI; Servicio de Nefrología, Hospital Galdakao-Usansolo. Galdácano, España., Mérida E; Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España., Camba MJ; Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Orense, España., Blázquez LA; Servicio de Nefrología, Hospital General Universitario de Guadalajara, Guadalajara, España., Alcaide MP; Servicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, España., Echarri R; Servicio de Nefrología, Hospital Universitario Infanta Sofia, Madrid, España.
Jazyk:	English; Spanish; Castilian
Zdroj:	Nefrologia [Nefrologia (Engl Ed)] 2021 Aug 11. Date of Electronic Publication: 2021 Aug 11.
DOI:	10.1016/j.nefro.2021.06.006
Abstrakt:	Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work, we described the acute changes during an HD session with a DF with citrate instead of acetate. Now, we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3mmol/L acetate and 16 weeks with 1mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, pre-HD ionic calcium and magnesium were significantly lower and paratiroid hormone (PTH) higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96±2.33kg/m 2 when patients switched from DF with acetate to citrate. HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long-term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status. (Copyright © 2021 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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