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Effects of Acetate‐Free Citrate‐Containing Dialysate on Metabolic Acidosis, Anemia, and Malnutrition in Hemodialysis Patients
Author(s) -
Kuragano Takahiro,
Kida Aritoshi,
Furuta Minoru,
Yahiro Mana,
Kitamura Rie,
Otaki Yoshinaga,
oguchi Hiroshi,
Matsumoto Akihide,
Nakanishi Takeshi
Publication year - 2012
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2011.01349.x
Subject(s) - metabolic acidosis , hemodialysis , medicine , anemia , bicarbonate , hemoglobin , albumin , acidosis , hematocrit , erythropoiesis , endocrinology , gastroenterology
Previously, dialysate contained small amounts of acetate as an alkaline buffer. Recently, acetate‐free dialysate (A[−]D) has been available. We evaluated the clinical effect of A(−)D over acetate‐containing dialysate (A(+)D) on acid–base balance, anemia, and nutritional status in maintenance hemodialysis (MHD) patients. Twenty‐nine patients on MHD were treated with A(+)D for 4 months (first A(+)D), switched to A(−)D for 4 months, and returned to A(+)D for the next 4‐month period (second A(+)D). Metabolic acidosis: Serum bicarbonate (HCO3 ‐ ) levels did not change in patients with normal HCO3 ‐ levels (≥20 mEq/L) throughout the study. Meanwhile, in patients with initially low HCO3 ‐ levels, it was significantly increased during the A(−)D period only. Anemia: In patients with target hemoglobin (Hb) ≥10 g/dL, Hb levels were maintained during the study period, even if the dose of erythropoiesis‐stimulating agents (ESAs) decreased. In patients with low Hb levels, it was significantly increased in the A(−)D period without increasing ESA or iron doses. Nutritional Condition: In patients with normal albumin levels (≥3.8 g/dL), albumin did not change throughout the study period. However, in patients with lower albumin levels, it was significantly increased during the A(−)D period. These improvements in metabolic acidosis, anemia, and nutrition in the A(−)D period completely dissipated during the second A(+)D period. Hemodialysis (HD) with A(−)D may improve a patient's clinical status with intractable metabolic acidosis, hyporesponsiveness to ESA, and malnutrition that were not normalized in HD with A(+)D.