Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study
Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work we described the acute changes during an H...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | Nefrología (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2013251421001267 |
| _version_ | 1797996239531278336 |
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| author | Patricia de Sequera Rafael Pérez-García Manuel Molina Gracia Álvarez-Fernández Rosa Inés Muñoz-González Evangelina Mérida Maria Jesús Camba Luis Alberto Blázquez Maria Paz Alcaide Rocío Echarri |
| author_facet | Patricia de Sequera Rafael Pérez-García Manuel Molina Gracia Álvarez-Fernández Rosa Inés Muñoz-González Evangelina Mérida Maria Jesús Camba Luis Alberto Blázquez Maria Paz Alcaide Rocío Echarri |
| author_sort | Patricia de Sequera |
| collection | DOAJ |
| description | Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work we described the acute changes during an HD session with a DF with citrate instead of acetate. Now we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3 mmol/L acetate and 16 weeks with 1 mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, preHD ionic calcium and magnesium were significantly lower and PTH higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96 ± 2.33 kg/m2 when patients switched from LD with acetate to citrate.HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status. Resumen: La hemodiálisis (HD) con líquido de diálisis (LD) con bicarbonato requiere la presencia de un acido para prevenir la precipitación del carbonato de calcio y magnesio. El acido más usado es el acido acético, con él se han descrito diversas complicaciones. En un trabajo previo describimos los cambios agudos, durante una sesión, en los pacientes en HD con un LD con citrato en lugar de acetato, en este referimos los resultados a medio plazo, 16 semanas.Es un estudio prospectivo, multicéntrico, cruzado y randomizado, donde 56 pacientes en HD con bicarbonato tres veces a la semana se dializaron 16 semanas con 3 mmol/L acetato y 16 semanas con 1 mmol/L de citrato. Se incluyeron pacientes mayores de 18 años con una estancia en HD previa superior a 3 meses y con fistula arteriovenosa normofuncionante. Se recogieron mensualmente datos epidemiológicos, de diálisis, bioimpedancia, bioquímica pre y postHD, así como los episodios de hipotensión.Después de 16 semanas de tratamiento con citrato el calcio iónico y el magnesio preHD eran significativamente inferiores y la PTH mas alta, que en el periodo con acetato. No se observo diferencias en la eficacia de la diálisis. Los episodios de hipotensión fueron significativamente más frecuentes con acetato que con citrato: 311 (14.1%) vs 238 (10.8%) sesiones. El índice de masa magra se incremento en 0.96 ± 2.33 kg/m2 cuando los pacientes pasaron de LD con acetato a citrato.La HD con citrato modifica varios parámetros del metabolismo óseo-mineral, no solo de forma aguda como se había descrito, sino también a medio plazo. La sustitución del acetato por el citrato mejora la estabilidad hemodinámica, produciendo menos hipotensiones y puede mejorar el estado nutricional.ClinicalTrials.gov NCT03319680. |
| first_indexed | 2024-04-11T10:13:18Z |
| format | Article |
| id | doaj.art-d70812b4709542029bbd1499ebe4bce2 |
| institution | Directory Open Access Journal |
| issn | 2013-2514 |
| language | English |
| last_indexed | 2024-04-11T10:13:18Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología (English Edition) |
| spelling | doaj.art-d70812b4709542029bbd1499ebe4bce22022-12-22T04:30:01ZengElsevierNefrología (English Edition)2013-25142022-05-01423327337Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat studyPatricia de Sequera0Rafael Pérez-García1Manuel Molina2Gracia Álvarez-Fernández3Rosa Inés Muñoz-González4Evangelina Mérida5Maria Jesús Camba6Luis Alberto Blázquez7Maria Paz Alcaide8Rocío Echarri9Departamento de Medicina, Universidad Complutense, Madrid, Spain; Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain; Corresponding author.Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, SpainServicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, SpainServicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, SpainServicio de Nefrología, Hospital Galdakao-Usansolo, Galdácano, SpainServicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, SpainServicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Orense, SpainServicio de Nefrología, Hospital General Universitario de Guadalajara, Guadalajara, SpainServicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, SpainServicio de Nefrología, Hospital Universitario Infanta Sofia, Madrid, SpainHemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work we described the acute changes during an HD session with a DF with citrate instead of acetate. Now we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3 mmol/L acetate and 16 weeks with 1 mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, preHD ionic calcium and magnesium were significantly lower and PTH higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96 ± 2.33 kg/m2 when patients switched from LD with acetate to citrate.HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status. Resumen: La hemodiálisis (HD) con líquido de diálisis (LD) con bicarbonato requiere la presencia de un acido para prevenir la precipitación del carbonato de calcio y magnesio. El acido más usado es el acido acético, con él se han descrito diversas complicaciones. En un trabajo previo describimos los cambios agudos, durante una sesión, en los pacientes en HD con un LD con citrato en lugar de acetato, en este referimos los resultados a medio plazo, 16 semanas.Es un estudio prospectivo, multicéntrico, cruzado y randomizado, donde 56 pacientes en HD con bicarbonato tres veces a la semana se dializaron 16 semanas con 3 mmol/L acetato y 16 semanas con 1 mmol/L de citrato. Se incluyeron pacientes mayores de 18 años con una estancia en HD previa superior a 3 meses y con fistula arteriovenosa normofuncionante. Se recogieron mensualmente datos epidemiológicos, de diálisis, bioimpedancia, bioquímica pre y postHD, así como los episodios de hipotensión.Después de 16 semanas de tratamiento con citrato el calcio iónico y el magnesio preHD eran significativamente inferiores y la PTH mas alta, que en el periodo con acetato. No se observo diferencias en la eficacia de la diálisis. Los episodios de hipotensión fueron significativamente más frecuentes con acetato que con citrato: 311 (14.1%) vs 238 (10.8%) sesiones. El índice de masa magra se incremento en 0.96 ± 2.33 kg/m2 cuando los pacientes pasaron de LD con acetato a citrato.La HD con citrato modifica varios parámetros del metabolismo óseo-mineral, no solo de forma aguda como se había descrito, sino también a medio plazo. La sustitución del acetato por el citrato mejora la estabilidad hemodinámica, produciendo menos hipotensiones y puede mejorar el estado nutricional.ClinicalTrials.gov NCT03319680.http://www.sciencedirect.com/science/article/pii/S2013251421001267HemodiálisisAcetatoCitratoCalcioMagnesioLíquido de diálisis |
| spellingShingle | Patricia de Sequera Rafael Pérez-García Manuel Molina Gracia Álvarez-Fernández Rosa Inés Muñoz-González Evangelina Mérida Maria Jesús Camba Luis Alberto Blázquez Maria Paz Alcaide Rocío Echarri Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study Nefrología (English Edition) Hemodiálisis Acetato Citrato Calcio Magnesio Líquido de diálisis |
| title | Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study |
| title_full | Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study |
| title_fullStr | Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study |
| title_full_unstemmed | Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study |
| title_short | Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study |
| title_sort | advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid a randomized abc treat study |
| topic | Hemodiálisis Acetato Citrato Calcio Magnesio Líquido de diálisis |
| url | http://www.sciencedirect.com/science/article/pii/S2013251421001267 |
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