Abstract: FR-PO815

Effects of Citrasate® and Citrasate Dry ® on Serum Calcium and iPTH

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Anderson, Ludmila, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Ficociello, Linda H., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Balter, Paul, Renal Research Institute, New York, New York, United States
  • Topping, Alice, Renal Research Institute, New York, New York, United States
  • Mullon, Claudy, Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Citrasate and Citrasate Dry provide hemodialysis dialysates (CD) containing 2.4 mEq of citric acid (citrate) per liter. Citrate binds calcium and is rapidly metabolized in the liver. The objective of this analysis was to explore CD effects on corrected serum calcium (CSC) and iPTH in chronic kidney disease patients on thrice weekly hemodialysis (HD) who were converted from acetate acidified dialysates without citrate (AD) to CD.

Methods

Data for CD treated patients from 18 clinics were analyzed. Mean pre-HD laboratory values for the last three months of AD were compared with mean values for the first three months of CD (paired t-test, McNemar, chi2, α=.05). Subanalyses were carried out by CSC (<8.4, 8.4-9.5, 9.6-10.2, >10.2 mg/dl) and iPTH (<130, 130-600, >600 pg/ml) ranges during the three months of AD. Changes in concomitant medications (in-center vitamin D [VitD], Cinacalcet, Ca-based phosphate binders [CaPB]) were explored.

Results

In total, 1,321 patients were analyzed. Mean pre-HD values for three months of AD and changes following the CD conversion are summarized in the Table.

Conclusion

On average, CSC decreased -5.6% and iPTH increased +4.4% during the first three months of CD. Subanalyses indicated that observed changes in CSC and iPTH varied according to their range during the last three months of AD. Limitations of the analysis include the cross-sectional nature of our assessment and inability to account for all clinical practices.

 All PatientsAD CSC (mg/dl)
<8.4
AD CSC (mg/dl)
8.4-9.5
AD CSC (mg/dl)
>9.5<=10.2
AD CSC (mg/dl)
>10.2
AD iPTH (pg/ml)
< 130
AD iPTH (pg/ml)
130-600
AD iPTH (pg/ml)
>600
Number of patients analyzed
AD iPTH (pg/ml)
CD iPTH Change
1,120
596.8
+26.1
195
646.7
-17.3
742
595.9
+21.6
169
540.9
+99.8
14
624.8
-16.1
60
79.2
+141.2
670
364.5
+74.9
390
1,075.5
-75.4
Number of patients analyzed
AD CSC (mg/dl)
CD iPTH change
1,165
8.9
-0.05
202
8.0
+0.2
766
9.0
-0.05
179
9.7
-0.3
18
10.6
-0.7
94
9.1
-0.2
678
8.8
-0.05
393
8.9
-0.01
AD in-center VitD use (%)
CD VitD use change
78.3
0
78.0
+2.8
79.2
+0.9
76.4
-2.8
65.1
-25.9
48.2
-3.2
78.6
+0.5
84.5
+2.1
AD CaPB use (%)
CD CaPB use change
22.5
+1.0
26.1
+4.6
22.8
+0.7
18.3
-1.5
19.1
-4.8
28.4
0
26.3
+1.2
14.8
+0.9
AD Cinacalcet use (%)
CD Cinacalcet use change
29.3
+2.7
39.9
+2.1
28.1
+3.0
24.5
+2.4
23.8
-4.8
13.8
-1.0
24.2
+2.1
42.7
+4.3

Funding

  • Commercial Support