Effects of citrate dialysate in chronic dialysis: a multicentre randomized crossover study
| Autor: | Peter Heering, Olaf Loke, Dirk Meinke, Justyna Kozik-Jaromin, Jan Galle, Michael Schmitz, Klaus Kalb, Bernhard Fach, Peter Rawer |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Alkalosis medicine.medical_treatment 030232 urology & nephrology Urology 030204 cardiovascular system & hematology Citric Acid 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Renal Dialysis Dialysis Solutions medicine Humans Hypocalcaemia Dialysis Aged Calcium Chelating Agents Calcium metabolism Transplantation Creatinine Cross-Over Studies business.industry Middle Aged CIDI medicine.disease Crossover study Surgery Treatment Outcome chemistry Nephrology Hypercalcemia Kidney Failure Chronic Female Hemodialysis business |
| Zdroj: | Nephrology Dialysis Transplantation. 31:1327-1334 |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | Background 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. Methods 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. Results 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. Conclusions 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. |
| Databáze: | OpenAIRE |
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