Abstract: SA-PO789

Multicenter, Prospective, Randomized, Crossover Trial to Demonstrate the Benefits of Hemodialysis without Acetate (with Citrate): ABC-Treat Study

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • De Sequera, Patricia, Hospital Infanta Leonor, Madrid, Spain
  • Perez-Garcia, Rafael, Hospital Infanta Leonor, Madrid, Spain
  • Molina, Manuel, H Santa Lucia, Murcia, Spain

Group or Team Name

  • Spanish ABC-treat group study
Background

Dialysis fluid, essential element in hemodialysis, is manufactured in situ by the monitors mixing 3 basic components: treated water, bicarbonate concentrate and acid concentrate. We have 2 types of acid concentrate: acetate (A) and citrate (C).
Objective:
To evaluate the impact of HD with C on calcium metabolism, acid base status, inflammation, coagulation and hemodynamic stability compared to HD with A.

Methods

Multicenter, prospective, randomized and crossover study, 32 weeks, 16 with 3mmol/l A (SoftPac®) and 16 with 1mmol/l C (Select BagCitrate®).
Inclusion criteria: adults in HD for at least 3 months by arteriovenous fistula, and sign informed consent.
Exclusion criteria: allergy or intolerance to citrate, intercurrent inflammatory diseases, significant cognitive impairment.
Epidemiological, dialysis, and biochemical data were collected. Visual clotting scores of the dialyser and venous chambers were quantified.

Results

53 patients were included, 44(83%) males, average age:64(16,5) years, dialysis technique HD/HDF: 18(34%)/35(66%).
Mean values of the dialysis parameters: Blood flow: 392,8(48,2) ml/min; kt: 53,5(8,2) L, infusion volume in HDF: 26,9(3,7) L, dialysate bicarbonate concentrations: 31,5(1,6) mmol/l.
Results Of the 32 patients who completed the study on 03/31/2017 in table.
Coagulation scores from either chambers and dialyser, as well as the number of hypotension episodes recorded during the sessions were lower with the C (p=0.00). We did not find differences neither in the inflammatory parameters measured with C-reactive protein and IL-6, nor in the preHD bicarbonate values.

Conclusion

Dialysis with C modifies most phosphocalcic metabolism parameters, not only acutely as previously described, but also in the long term, and decreases/avoids postdialysis alkalaemia. We have found lower coagulation scores and arterial hypotension episodes with C.

 AcetateCitrateSignificance
PreHD Ca++ (mmol/L)1,12 (0,0)1,10 (0,0)0.02
PreHD P (mg/dl)4.0 (1,1)4,4 (1,2)0.04
PreHD Mg (mg/dl)2,2 (0,3)2,0 (0,0)0.00
PreHD PTH (pg/ml)301,1 (217)367,6 (215)0.04
PostHD Ca++ (mmol/L)1,2 (0,1)1,1 (0,0)0.00
PostHD Mg (mg/dl)1,9 (0,1)1,8 (0,1)0.02
PostHD PTH (pg/ml)204,6 (168)300 (231)0.00
PostHD Bicarbonate (mmol/L)28,3 (2,3)26,5 (1,9)0,02

Funding

  • Commercial Support