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Titolo Citrate- vs. acetate-based dialysate in bicarbonate haemodialysis: consequences on haemodynamics, coagulation, acid-base status, and electrolytes
Autore Luca Gabutti*1, Barbara Lucchini2, Claudio Marone3, Lorenzo Alberio4 and Michel Burnier5 - Address: 1Division of Nephrology, Ospedale la Carità, Via Ospedale, 6600 Locarno, Switzerland, 2Department of Internal Medicine, Ospedale Carità, Locarno, Switzerland, 3Department of Internal Medicine, Ospedale San Giovanni, Bellinzona, Switzerland, 4Department of Hematology, University Hospital of Bern, Bern, Switzerland and 5Division of Nephrology, University Hospital of Lausanne, Lausanne, Switzerland
Referenza BMC Nephrology 2009; 10: 7 doi: 10.1186/1471-2369-10-7
Contenuto 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 acetatebased 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, postdialysis 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.
Data 23.03.2009
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