Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
Biochemistry and Molecular Genetics Department-CDB, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
Toxins (Basel). 2024 Oct 1;16(10):426. doi: 10.3390/toxins16100426.
Modern hemodialysis employs weak acids as buffers to prevent bicarbonate precipitation with calcium or magnesium. Acetate, the most used acid, is linked to chronic inflammation and poor dialysis tolerance. Citrate has emerged as a potential alternative, though its effect on dialysis efficiency is not clear. This study aims to compare the efficacy of acetate- and citrate-based dialysates, focusing on protein-bound uremic toxins and dialysis doses. This single-center prospective crossover study includes prevalent patients participating in a thrice-weekly online hemodiafiltration program. Four dialysates were tested: two acetate-based (1.25 and 1.5 mmol/L calcium) and two citrate-based (1.5 mmol/L calcium with 0.5 and 0.75 mmol/L magnesium). Pre- and post-dialysis blood samples of eighteen patients were analyzed for urea, creatinine, p-cresyl sulfate, indoxyl sulfate, and albumin. Statistical significance was assessed using paired -tests and repeated measures of ANOVA. There were no significant differences in dialysis dose (Kt), urea, creatinine, or indoxyl sulfate reduction ratios between acetate- and citrate-based dialysates. However, a significant decrease in the reduction ratio of p-cresyl sulfate was observed with the acetate dialysate containing 1.25 mmol/L calcium and the citrate dialysate with 0.5 mmol/L magnesium compared to the acetate dialysate containing 1.5 mmol/L calcium and the citrate dialysate with 0.75 mmol/L magnesium (51.56 ± 4.75 and 53.02 ± 4.52 vs. 65.25 ± 3.38 and 58.66 ± 4.16, 0.007). No differences in dialysis dose were found between acetate- and citrate-based dialysates. However, citrate dialysates with lower calcium and magnesium concentrations may reduce the albumin displacement of p-cresyl sulfate. Further studies are needed to understand the observed differences and optimize the dialysate composition for the better clearance of protein-bound uremic toxins.
现代血液透析采用弱酸作为缓冲剂，以防止碳酸氢盐与钙或镁沉淀。最常用的酸是醋酸盐，它与慢性炎症和透析耐受性差有关。柠檬酸盐已成为一种潜在的替代品，但其对透析效率的影响尚不清楚。本研究旨在比较基于醋酸盐和柠檬酸盐的透析液的疗效，重点是蛋白质结合尿毒症毒素和透析剂量。这项单中心前瞻性交叉研究包括参加每周三次在线血液透析滤过计划的现有患者。测试了四种透析液：两种基于醋酸盐（1.25 和 1.5 mmol/L 钙）和两种基于柠檬酸盐（1.5 mmol/L 钙，0.5 和 0.75 mmol/L 镁）。对 18 名患者的透析前和透析后血样进行尿素、肌酐、对甲苯磺酸、吲哚硫酸和白蛋白分析。使用配对检验和重复测量方差分析评估统计学意义。在基于醋酸盐和柠檬酸盐的透析液之间，透析剂量（Kt）、尿素、肌酐或吲哚硫酸还原率没有显著差异。然而，与基于醋酸盐的透析液中含有 1.5 mmol/L 钙和柠檬酸盐的透析液中含有 0.75 mmol/L 镁相比，基于醋酸盐的透析液中含有 1.25 mmol/L 钙和柠檬酸盐的透析液中含有 0.5 mmol/L 镁时，对甲苯磺酸还原率显著降低（51.56 ± 4.75 和 53.02 ± 4.52 与 65.25 ± 3.38 和 58.66 ± 4.16，0.007）。在基于醋酸盐和柠檬酸盐的透析液之间未发现透析剂量的差异。然而，钙和镁浓度较低的柠檬酸盐透析液可能会减少对甲苯磺酸与白蛋白的置换。需要进一步研究以了解观察到的差异，并优化透析液组成，以更好地清除蛋白质结合的尿毒症毒素。
