Panichi Vincenzo, Fiaccadori Enrico, Rosati Alberto, Fanelli Roberto, Bernabini Giada, Scatena Alessia, Pizzarelli Francesco
Nephrology and Dialysis Unit, Versilia Hospital, 55034 Lido Camaiore (Lucca), Italy.
Nephrology and Dialysis Unit, Parma Hospital, 43100 Parma, Italy.
ScientificWorldJournal. 2013 Dec 3;2013:703612. doi: 10.1155/2013/703612. eCollection 2013.
Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF).
Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate.
In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β 2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range.
Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.
枸橼酸盐具有抗凝特性且对炎症有有益作用，但存在诱发低钙血症的潜在风险。目前，在慢性血液透析中，用碳酸氢盐透析液（BHD）替代醋酸盐透析液，但尚未在后置式在线血液透析滤过（OL-HDF）中进行过测试。
13例慢性稳定透析患者参加了一项短期初步研究。患者先接受为期一周（3次透析治疗）的含0.8 mmol/L枸橼酸盐透析液的BHD治疗，随后接受为期一周的使用标准碳酸氢盐透析液的后置式高容量OL-HDF治疗，以及为期一周的含0.8 mmol/L枸橼酸盐透析液的高容量OL-HDF治疗。
在枸橼酸盐OL-HDF治疗中，治疗前血浆C反应蛋白和β2微球蛋白水平显著降低；在前一种技术中治疗期间血浆醋酸盐水平升高，而在后一种技术中降低。在两种枸橼酸盐技术（OL-HDF和血液透析）中，离子钙水平均保持在正常范围内稳定。
如果我们的这些有前景的结果能在更广泛人群的长期研究中得到证实，那么使用枸橼酸盐透析液的OL-HDF可能代表了改善透析生物相容性的又一进步。
