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Abstract: FR-PO484

Dialysate Citrate and Mortality in the Dialysis Outcomes and Practice Patterns Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Urena Torres, Pablo A., AURA Nord Saint Ouen, Saint Ouen, France
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Guebre Egziabher, Fitsum, Hospital Albert Michallon, La Tronche, France
  • Combe, Christian, CHU de Bordeaux , Bordeaux, France
  • Jadoul, Michel Y., Cliniques Saint-Luc, University of Louvain Medical School, Brussels, Belgium
  • Inaba, Masaaki, Osaka City University Graduate School of Medicine, Osaka, Japan
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Jacquelinet, Christian, Agence de la biomedecine, Saint-Denis La Plaine, France

Metabolic acidosis is a common threat for hemodialysis patients, managed by alkaline dialysis baths. The main base is bicarbonate, to which small amounts of acetate or citrate may be added. These additives are metabolized to bicarbonate, mostly by the liver. In view of uncertainties about benefits and potential harms associated with citrate-containing dialysate we assess here whether citrate dialysate is associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS).


Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012 to 2017). Cox regression was used to model the association between dialysate containing bicarbonate with versus without citrate and mortality among DOPPS country/phases with at least 15 patients using citrate containing dialysate.


Citrate-containing dialysate use was most common in Japan, Italy, and Belgium (25, 23, 21% of DOPPS phase 6 patients) and used in < 10% of patients in other countries. Among 10,618 patients in DOPPS country/phases with at least 15 patients using citrate-containing dialysate, patient demographics, comorbidities, and labs were similar among patients using (14%) vs. not using (86%) dialysate citrate. After accounting for case mix, we did not observe an association between citrate containing dialysate use (any vs. none) and mortality, HR (95% CI) = 1.03 (0.85-1.23). Nor did we find evidence of a dose-dependent relationship when parameterizing dialysate citrate concentrations as 1, 2, and 3+ mEq/L.


The use of this emergent practice of citrate-containing dialysate was not associated with the risk of all-cause mortality in hemodialysis patients participating in the DOPPS. Clinical indications for the use citrate dialysate deserve further investigation in future studies.


  • NIDDK Support