Comparison of citrate dialysate in pre- and post-dilution online hemodiafiltration: effect on clot formation and adequacy of dialysis in hemodialysis patients.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 8701128 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-6049 (Electronic) Linking ISSN: 0886022X NLM ISO Abbreviation: Ren Fail Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: New York, N.Y. : M. Dekker, c1987-

Hemodiafiltration*; Humans ; Renal Dialysis ; Citric Acid ; Dialysis Solutions ; Quality of Life ; Citrates ; Anticoagulants/therapeutic use

Background: Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes.
Method: Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.
Results: The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase ( p  < 0.001 in the baseline phase, p  = 0.001 in phase 1, and p  = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI -0.81 to -0.19, p  = 0.002). The patient's quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 ( p  = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.
Conclusion: Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.

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Keywords: Adequacy of dialysis; citrate dialysate; clot formation; hemodialysis; online hemodiafiltration; post- dilution; pre-dilution

2968PHW8QP (Citric Acid)
0 (Dialysis Solutions)
0 (Citrates)
0 (Anticoagulants)

Date Created: 20240108 Date Completed: 20240109 Latest Revision: 20240111

20240111

PMC10776067

10.1080/0886022X.2024.2302109

38189095