Schmitz Michael, Loke Olaf, Fach Bernhard, Kalb Klaus, Heering Peter J, Meinke Dirk, Rawer Peter, Galle Jan, Kozik-Jaromin Justyna
Department of Nephrology and General Medicine, Städtisches Klinikum Solingen GmbH, Solingen, Germany.
Nephrologische Gemeinschaftspraxis Dialyse und Lipidapherese, Lüdenscheid, Germany.
Nephrol Dial Transplant. 2016 Aug;31(8):1327-34. doi: 10.1093/ndt/gfv347. Epub 2015 Oct 5.
Although citrate dialysate (CiDi) is regarded to be safe, dialysis modalities using higher dialysate volumes, like haemodiafiltration (HDF), may expose patients to higher citrate load and thus increase the risk of complications. We investigated the residual risk of CiDi compared with standard dialysate (StDi) in patients on different dialysis modalities and its effect on dialysis dose.
In a multicentre randomized crossover study, 92 dialysis patients (HDF post-dilution: n = 44, HDF pre-dilution: n = 26, haemodialysis: n = 25) were treated for 4 weeks with each dialysate (StDi and CiDi). Hypocalcaemia (ionized calcium ≤0.9 mmol/L), alkalosis (pH ≥7.55), post-treatment bicarbonate ≥32 mmol/L, pre-treatment bicarbonate ≥27 mmol/L, intra-dialytic events (IEs) and adverse events (AEs) between dialysis sessions were investigated as primary end points. The secondary objective was dialysis efficacy, i.e. dose and removal ratios of urea, creatinine, phosphate and β-2-microglobulin.
Post-dialysis overcorrection of bicarbonate (>32 mmol/L) was less frequent with CiDi (P = 0.008). Other predefined calcium and acid-base disturbances did not vary. There was no significant difference in IE. However, more patients developed AEs such as fatigue, muscle spasms or pain using CiDi (StDi: 41 versus CiDi: 55 patients, P = 0.02), particularly in the first 2 weeks of exposure. Dialysis efficacy was comparable with both dialysates.
It can be confirmed that CiDi is not associated with the development of severe calcium and acid-base disorders, even when dialysis modalities with higher citrate loads are used. However, a refinement of the CiDi composition to minimize AEs is necessary.
尽管柠檬酸透析液（CiDi）被认为是安全的，但使用较高透析液量的透析方式，如血液透析滤过（HDF），可能会使患者暴露于更高的柠檬酸盐负荷下，从而增加并发症的风险。我们研究了不同透析方式患者中CiDi与标准透析液（StDi）相比的残留风险及其对透析剂量的影响。
在一项多中心随机交叉研究中，92例透析患者（后稀释血液透析滤过：n = 44，前稀释血液透析滤过：n = 26，血液透析：n = 25）分别接受每种透析液（StDi和CiDi）治疗4周。将透析后低钙血症（离子钙≤0.9 mmol/L）、碱中毒（pH≥7.55）、治疗后碳酸氢盐≥32 mmol/L、治疗前碳酸氢盐≥27 mmol/L、透析期间的透析内事件（IEs）和不良事件（AEs）作为主要终点进行研究。次要目标是透析疗效，即尿素、肌酐、磷酸盐和β-2-微球蛋白的剂量和清除率。
使用CiDi时，透析后碳酸氢盐过度校正（>32 mmol/L）的情况较少见（P = 0.008）。其他预定义的钙和酸碱紊乱情况没有差异。IE方面没有显著差异。然而，使用CiDi时更多患者出现了疲劳、肌肉痉挛或疼痛等AE（StDi组：41例患者，CiDi组：55例患者，P = 0.02），尤其是在暴露的前2周。两种透析液的透析疗效相当。
可以确认，即使使用柠檬酸盐负荷较高的透析方式，CiDi也与严重钙和酸碱紊乱的发生无关。然而，有必要对CiDi的成分进行优化以尽量减少AE。
