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Background Citric Acid Based Bicarbonate Dialysate (CiD) is increasingly used in hemodialysis to improve hemodynamic tolerance and hemocompatibility associated with Acetic Acid Based Bicarbonate dialysis (AcD). We sought to evaluate the mortality risk associated with different dialysate acidifiers. Methods We conducted a multicenter, historical cohort study; all adult incident hemodialysis patients registered in EMEA Fresenius Medical Care network since January 1st 2014 to October 31st 2018 were enrolled. We recorded dialysate acidifier composition for each dialysis session. In the primary analysis (intention-to-treat population), patients were assigned to the exposed group if they received CiD in more than 70% of sessions during the first three months (CiD70%), whereas non-exposed received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow up. Results We enrolled 10,121 incident patients during the study period. Of them, 371 met criteria for inclusion in CiD70%. After propensity score matching mortality was 11.43 (95%CI: 8.86 - 14.75) and 12.04 (95%CI: 9.44 - 15.35) deaths/100 person-years, in the CiD0% and CiD70% groups respectively (p=0.80). A similar association trend was observed in the secondary analysis. Conclusions We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite physicians were more inclined to prescribe CiD to subjects with worse medical conditions.

P1449MORTALITY RISK ASSOCIATED WITH ACETIC ACID BASED AND CITRIC ACID BASED BICARBONATE HEMODIALYSIS: A HISTORICAL COHORT STUDY