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Acetate free citrate-containing dialysate increase intact-PTH and BAP levels in the patients with low intact-PTH

Takahiro Kuragano13*, Minoru Furuta2, Mana Yahiro1, Aritoshi Kida1, Yoshinaga Otaki1, Yukiko Hasuike1, Akihide Matsumoto2 and Takeshi Nakanishi1

Author affiliations

1 Department of Internal Medicine Division of kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan

2 Seishoukai Aoi Hospital, Nishinomiya, Japan

3 Takahiro Kuragano, 1-1, Mukogawa cho, 663-8501, Nishinomiya, Japan

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Citation and License

BMC Nephrology 2013, 14:18  doi:10.1186/1471-2369-14-18

Published: 18 January 2013



Recently, acetate-free citrate containing dialysate (A(−)D) was developed. We have already reported about the significant effect of A(−)D on metabolic acidosis, anemia, and malnutrition in maintenance hemodialysis (MHD) patients. In this study, we compared the effect of A(−)D and acetate containing dialysate (A(+)D) on serum calcium and intact-parathyroid hormone (int-PTH) levels.


Single session study: Seventeen patients were treated with A(+)D in one session and also treated with A(−)D in another session. Serum levels of pH, HCO3-, total (t)-calcium, ionized (i)-calcium, and int-PTH were evaluated at the beginning and the end of each session. Cross over study: A total of 29 patients with MHD were treated with A(+)D for 4 months, switched to A(−)D for next 4 months, and returned to A(+)D for the final 4 months.


In single session study, serum i-calcium and t-calcium levels significantly increased, and int-PTH levels decreased after HD with A(+)D, whereas HD with A(−)D did not affect iCa and int-PTH. In cross over study, if all patients were analyzed, there was no significant difference in serum int-PTH or bone alkaline phosphatase (BAP) levels during each study period. In contrast, in the patients with low int-PTH (<60 pg/mL), serum levels of int-PTH and BAP were significantly increased during the A(−)D, without significant changes in serum t-calcium or i-calcium levels.


A(−)D containing citrate could affect calcium and PTH levels, and, in 4 month period of crossover study, increased int-PTH levels pararelled with increasing BAP levels, exclusively in MHD patients with low int-PTH levels.

Acetate free citrate-containing dialysate; Low intact-parathyroid hormone; Bone alkaline phosphatase; Total calcium; Ionized calcium