Open AccessEffects of citrate acid concentrate on hemodialysis adequacy, reuse, and quality of life: A prospective randomized crossover trial
Author(s) -
Shankar Prasad Nagaraju,
Srinivas Kosuru,
R. Parthasarathy,
Aswani Srinivas Mareddy,
Ravindra Prabhu Attur,
Dharshan Rangaswamy,
Shankar Prasad,
Sindhu Kaza,
Srinivas Vinayak Shenoy,
Karan Saraf,
Sindhura Lakshmi Koulmane Laxminarayana,
Uday Venkat Mateti,
Vasudeva Guddattu
Publication year - 2018
Publication title -
indian journal of nephrology/indian journal of nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 24
eISSN - 1998-3662
pISSN - 0971-4065
DOI - 10.4103/ijn.ijn_154_17
Subject(s) - medicine , hemodialysis , crossover study , randomized controlled trial , quality of life (healthcare) , bicarbonate , end stage renal disease , acidosis , prospective cohort study , urology , intensive care medicine , alternative medicine , nursing , pathology , placebo
We conducted a randomized crossover trial to identify whether the use of citrate dialysate (CD) for bicarbonate hemodialysis is beneficial compared to regular acetate dialysate (AD) in terms of adequacy, reuse, and quality of life. Thirty-two stable end-stage renal disease patients on twice-weekly maintenance hemodialysis were randomly assigned to CD or AD fluid in a single-blinded randomized prospective crossover trial of 1-year duration. The primary outcomes studied were the impact of CD in comparison with AD on hemodialysis adequacy, reuse of dialyzer, and quality of life. Secondary outcomes studied were the effect on intradialytic hypotension, acidosis correction, and episodes of symptomatic hypocalcemia. A total number of 28 patients underwent a total of 1456 sessions of hemodialysis with CD over 6 months and 1456 sessions with AD over 6 months. There was a significant increase in dialyzer reuse with the use of CD ( P = 0.02). There was no difference in dialyzer adequacy as measured by Single pool Kt/V (spKt/V) ( P = 0.840) and urea reduction ratio (%) ( P = 0.90). Quality of life did not differ between the two groups. No statistically significant difference was observed in predialysis arterial pH ( P = 0.23) serum bicarbonate (0.17) and calcium change ( P = 0.16). CD is safe and equally effective as compared to AD. It significantly improves the reuse of dialyzer but it does not offer any added advantage in terms of improvement in hemodialysis adequacy and quality of care.