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Clinical Journal of the American Society of Nephrology

Year: 2009  |  Volume: 4  |  Issue: 9  |  Page No.: 1459 - 1464

Increased Efficiency of Hemodialysis with Citrate Dialysate: A Prospective Controlled Study

R. J Kossmann, A Gonzales, R Callan and S. Ahmad


Background and objectives: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect. This study examines the effect of CD on dialysis efficiency, measured as eKt/Vurea, and predialysis concentrations of BUN, creatinine, phosphate, and β-2 microglobulin in chronic dialysis units.

Design, settings, participants, & measurements: Three outpatient chronic hemodialysis units with 142 patients were switched to CD for 6 mo. Using each patient's prior 6 mo on regular bicarbonate dialysate acidified by acetate (AD) as control, eKt/Vurea was compared with that of CD. Follow-up data for 7 mo after the study were collected from about one-half of the participants remaining on CD and the others returned to AD.

Results: eKt/Vurea, increased (P < 0.0001) from pre-CD value of 1.51 ± 0.01 to 1.57 ± 0.01 with CD. During CD use β-2 microglobulin levels declined (P = 0.0001) from 28.1 ± 10.0 to 25.9 ± 10.0. Similarly, the concentrations of BUN, creatinine, and phosphate also decreased on CD (P < 0.008). In the poststudy period, eKt/Vurea for the patients staying on CD remained unchanged at 1.60 ± 0.17 versus 1.59 ± 0.18 (P = NS), whereas in those returning to AD the eKt/Vurea decreased from 1.55 ± 0.20 to 1.52 ± 0.17 (P < 0.0001).

Conclusions: Data suggest that CD use is associated with increased solute removal.

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