Department of Nephrology and Renal Transplantation, Hospital Clínic, Barcelona, Spain,
Department of Nephrology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Blood Purif. 2021;50(6):914-920. doi: 10.1159/000513419. Epub 2021 Feb 3.
The composition of the dialysate is a crucial feature in the dialysis treatment. Two of its most debated elements are the optimal calcium concentration and the use of acetate as a buffer. Moreover, among the different alternatives to achieve acetate-free dialysis, the use of citrate is postulated as the most suitable option. The objective of this study is to identify the potential beneficial effects of citrate when compared to acetate dialysate (AD) both in short-term effects (especially regarding intradialytic calcium balance and cardiac damage biomarkers) and in medium-term ones with CKD-mineral and bone disorder (CKD-MBD) and inflammatory biomarkers measured after twelve sessions performed with each dialysate.
This is a unicentric, cross-over, prospective study. Each patient underwent 24 dialysis sessions, 12 with each dialysate buffer. Blood samples were taken in 2 different sessions with each acidifier. They include CKD-MBD and inflammatory biomarkers. The calcium concentration of both dialysates was 1.5 mmol/L, while all other dialysis parameters and patients' treatment remained unchanged during the study period.
When comparing AD and citrate dialysate (CD), there were no differences in pre-dialysis ionized calcium (iCa) (1.11 vs. 1.08 mmol/L) in both groups. However, there was a significant increase in iCa with the use of AD in immediate and 30-min post-dialysis blood samples. In contrast, iCa levels remained stable with the use of citrate. Inflammatory biomarkers were also reduced after the use of CD.
The use of citrate provides interesting advantages when compared to acetate. It maintains iCa levels stable during dialysis sessions with a neutral or negative effect on calcium balance, and it improves the chronic inflammatory condition that comes with long-time hemodialysis treatment. These beneficial effects may lead to an improvement in clinical outcomes.
透析液的组成是透析治疗的一个关键特征。其中最具争议的两个元素是最佳钙浓度和使用醋酸盐作为缓冲剂。此外，在实现无醋酸盐透析的不同替代方案中，使用柠檬酸盐被认为是最合适的选择。本研究的目的是确定与醋酸盐透析液（AD）相比，柠檬酸盐在短期效果（特别是在透析过程中钙平衡和心脏损伤生物标志物方面）和中期效果（包括慢性肾脏病-矿物质和骨异常（CKD-MBD）和炎症生物标志物）方面的潜在有益效果，在每种透析液进行 12 次透析后测量。
这是一项单中心、交叉、前瞻性研究。每位患者接受了 24 次透析，其中 12 次使用每种透析液缓冲液。在每个酸化剂的 2 个不同的透析过程中采集血液样本。它们包括 CKD-MBD 和炎症生物标志物。两种透析液的钙离子浓度均为 1.5mmol/L，而在研究期间，所有其他透析参数和患者的治疗均保持不变。
在比较 AD 和柠檬酸盐透析液（CD）时，两组患者透析前离子钙（iCa）（1.11 对 1.08mmol/L）无差异。然而，在使用 AD 后，iCa 在即时和 30 分钟后透析血样中显著增加。相比之下，使用柠檬酸盐时 iCa 水平保持稳定。使用 CD 后炎症生物标志物也减少了。
与醋酸盐相比，使用柠檬酸盐具有有趣的优势。它在透析过程中保持 iCa 水平稳定，对钙平衡有中性或负作用，并改善长期血液透析治疗带来的慢性炎症状况。这些有益的效果可能会导致临床结果的改善。
