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Kidney Week

Abstract: FR-PO485

Hemodialysis with Citrate Dialysate Does Not Harm Patients: Results from an European NephroCare Cohort

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Chazot, Charles, NephroCare France, Fresnes, France
  • Neri, Luca, Fresenius Medical Care Italia, Vaiano Cremasco, Italy
  • Bellocchio, Francesco, Fresenius Medical Care Italia, Vaiano Cremasco, Italy
  • Jean, Guillaume, NephroCare Tassin-Charcot, Sainte Foy Les Lyon, France
  • Jirka, Tomas, Fresenius Medical Care, Bad Homburg, Germany
  • Kircelli, Fatih, Fresenius Medical Care, Bad Homburg, Germany
  • Levannier, Martial, Nephrocare Beziers, Beziers, France
  • Attaf, David, Fresenius, Fresnes, France
  • Barbieri, Carlo, Fresenius Medical Care, Bad Homburg, Germany
  • Stuard, Stefano, Fresenius Medical Care, Bad Homburg, Germany
  • Canaud, Bernard J., FMC Deutschland GmbH, Bad Homburg, Germany

Chronic hemodialysis (HD) using citrate dialysate is prescribed for improving dialysis tolerance and reducing heparin needs. Recently the safety of citrate (Ci) has been challenged by a French retrospective study. We report a mortality analysis in incident HD patients treated in the NephroCare dialysis centers in France, Turkey and Czech Republic in which citrate concentrate were prescribed.


This a retrospective study including 10020 incident HD patients between 2014 and 2018. Data were extracted from the EuCliD5 database. Patient survival was analyzed from three cohort studies designed to address different potential sources of biases. Patients were considered Ci+ if 70% of dialysis sessions were performed with Ci all along their lifetime (Study 1) or during the first 3 months of dialysis (Study 2). Study 3 included time-varying Ci exposure and time-varying PS score (monthly and 6-monthly averages) in a proportional hazard Cox regression to address variation in dialysate composition and patients’ characteristics.


Among 10020 enrolled patients, 435 were classified as Ci+. These patients were older with more severe comorbidities. In Study 1 , the mortality was higher in Ci+ patients (p<0.0001). After propensity score matching (PSM; 345 patients Ci+ and Ci-) mortality remained strictly superimposable (Figure 1). In Study 2, no difference in survival was found before or after PSM. The monthly exposure analysis (Study 3), including 3671 patients with 835 deaths, clearly showed that the risk of mortality was related to the propensity score reflecting more sever condition (HR:5.06 (2.05-12.51)) but not with the Ci (HR:0.83 (0.67-1.03)).


In the European NephroCare experience, no significant impact on survival was found in chronic HD patients under Ci+ dialysate as compared to standard dialysate treated patients.