Research article

Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes

Luca Gabutti¹ , Barbara Lucchini² , Claudio Marone³ , Lorenzo Alberio⁴ and Michel Burnier⁵

¹  Division of Nephrology, Ospedale la Carità, Via Ospedale, 6600 Locarno, Switzerland

²  Department of Internal Medicine, Ospedale la Carità, Locarno, Switzerland

³  Department of Internal Medicine, Ospedale San Giovanni, Bellinzona, Switzerland

⁴  Department of Hematology, University Hospital of Bern, Bern, Switzerland

⁵  Division of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland

author email corresponding author email

BMC Nephrology 2009, 10:7doi:10.1186/1471-2369-10-7

Published:	5 March 2009

Abstract

Background

A concentrate for bicarbonate haemodialysis acidified with citrate instead of acetate has been marketed in recent years. The small amount of citrate used (one-fifth of the concentration adopted in regional anticoagulation) protects against intradialyser clotting while minimally affecting the calcium concentration. The aim of this study was to compare the impact of citrate- and acetate-based dialysates on systemic haemodynamics, coagulation, acid-base status, calcium balance and dialysis efficiency.

Methods

In 25 patients who underwent a total of 375 dialysis sessions, an acetate dialysate (A) was compared with a citrate dialysate with (C+) or without (C) calcium supplementation (0.25 mmol/L) in a randomised single-blind cross-over study. Systemic haemodynamics were evaluated using pulse-wave analysis. Coagulation, acid-base status, calcium balance and dialysis efficiency were assessed using standard biochemical markers.

Results

Patients receiving the citrate dialysate had significantly lower systolic blood pressure (BP) (-4.3 mmHg, p < 0.01) and peripheral resistances (PR) (-51 dyne.sec.cm^-5, p < 0.001) while stroke volume was not increased. In hypertensive patients there was a substantial reduction in BP (-7.8 mmHg, p < 0.01). With the C+ dialysate the BP gap was less pronounced but the reduction in PR was even greater (-226 dyne.sec.cm^-5, p < 0.001). Analyses of the fluctuations in PR and of subjective tolerance suggested improved haemodynamic stability with the citrate dialysate. Furthermore, an increase in pre-dialysis bicarbonate and a decrease in pre-dialysis BUN, post-dialysis phosphate and ionised calcium were noted. Systemic coagulation activation was not influenced by citrate.

Conclusion

The positive impact on dialysis efficiency, acid-base status and haemodynamics, as well as the subjective tolerance, together indicate that citrate dialysate can significantly contribute to improving haemodialysis in selected patients.

Trial registration

ClinicalTrials.gov NCT00718289