Division of Nephrology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Ren Fail. 2024 Dec;46(2):2398709. doi: 10.1080/0886022X.2024.2398709. Epub 2024 Sep 9.
Interest in citrate-based dialysate (Cit-D) is growing due to its benefits, including anticoagulation and dialysis efficacy. However, research on safety and efficiency of Cit-D in high-volume hemodiafiltration (HDF) central concentrate delivery system (CCDS) is scarce. This study aimed to investigate the safety and efficacy of Cit-D when switching from acetate-based dialysate (Acet-D) in high-volume HDF CCDS. This is a retrospective analysis of 28 patients who underwent post-dilution online HDF CCDS, who switched from Acet-D to Cit-D. The study period was divided into 3 periods for analysis: 12 weeks using Acet-D (AD period), the first 12 weeks using Cit-D (CD-1 period), and the second 12 weeks using Cit-D (CD-2 period). We collected the laboratory, dialysis, and safety parameters in each period from electrical medical records. After switching from Acet-D to Cit-D, heparin dosage decreased by 17%, whereas the incidence of complications did not increase. Kt/V and urea reduction ratio increased by 4.6% and 2.1%, respectively. Pre-dialysis beta-microglobulin concentration decreased after using Cit-D. The corrected calcium levels decreased in the CD-1 period compared to the AD period, but in CD-2, they subsequently increased to levels similar to those observed during the AD period. Symptomatic hypocalcemia did not occur, and there was no significant difference in the incidence of hyperparathyroidism. Endotoxin levels and the bacterial culture of ultrapure dialysate were unremarkable throughout all periods. These results might suggest that Cit-D could potentially offer advantages over Acet-D, such as reducing the heparin dose and increasing dialysis efficiency, in patients undergoing high-volume HDF using CCDS.
由于柠檬酸盐透析液（Cit-D）具有抗凝和透析效果好等优点，因此越来越受到关注。然而，关于高容量血液透析滤过（HDF）中央集中供应系统（CCDS）中 Cit-D 的安全性和效率的研究很少。本研究旨在探讨在高容量 HDF 中央集中供应系统中从醋酸盐透析液（Acet-D）切换到 Cit-D 的安全性和有效性。这是一项回顾性分析，纳入了 28 名接受后稀释在线 HDF 中央集中供应系统的患者，这些患者从 Acet-D 切换到 Cit-D。研究期间分为 3 个时期进行分析：使用 Acet-D 的 12 周（AD 期）、使用 Cit-D 的前 12 周（CD-1 期）和使用 Cit-D 的后 12 周（CD-2 期）。我们从电子病历中收集每个时期的实验室、透析和安全性参数。从 Acet-D 切换到 Cit-D 后，肝素剂量减少了 17%，但并发症的发生率并未增加。Kt/V 和尿素清除率分别增加了 4.6%和 2.1%。使用 Cit-D 后，透析前β-微球蛋白浓度降低。与 AD 期相比，CD-1 期校正钙水平降低，但在 CD-2 期，它们随后增加到与 AD 期相似的水平。未发生症状性低钙血症，甲状旁腺功能亢进症的发生率也无显著差异。所有时期的内毒素水平和超纯透析液的细菌培养均无明显异常。这些结果可能表明，在使用 CCDS 进行高容量 HDF 的患者中，Cit-D 可能具有优于 Acet-D 的优势，例如减少肝素剂量和提高透析效率。
