Abstract: TH-PO267
Dialysate Buffer in Hemodialysis: Effect of Practice Patterns on Serum PTH
Session Information
- Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Urena Torres, Pablo A., Aura Paris, Paris, France
- Seris, Pascal, Aura Paris, Paris, France
- Kolko-Labadens, Anne, Aura Paris, Paris, France
- Chazot, Charles, Aura Paris, Paris, France
Background
We report the analysis of 3 dialysate (D) acidic buffers on serum PTH in 4 dialysis units in Paris (France) area.
Methods
Data from prevalent hemodialysis (HD) patients (pts) treated in 4 units were collected in the 4th quarter 2022 and analyzed with Kruskal-Wallis and stepwise logistic regression tests. The biology lab is common to the 4 units. PTH was assessed using the Architect Intact PTH assay®.
Results
The 529 pts were 64 y.o. with 35% females, dialysis vintage: 47 months, Charlson index: 10. The acidic buffers were acetate (30.7%), hydrochloric acid (HCl) (35.7%) and citric acid (citrate) (33.6%). Pts on acetate were significantly younger (59 years) versus 67.5 and 66 years on HCl and citrate (p=0.001), with a lower Charlson index (9 versus 10 (0.001). Pts on HCl had significantly lower serum PTH levels; serum magnesium was significantly lower in citrate group; calcium, phosphate, native vitamin D were not different (Table 1). Muscle cramps during the dialysis were found in 10.2% (citrate), 8.5% (HCl) and 6.2% (acetate, p=0.027). The D calcium is reported in Table 1. The proportion of pts on calcimimetics and active vitamin D did not differ between groups. Factors associated with a PTH >612 pg/ml were age (-0.012, p<0.04), acetate buffer (0.065, p<0.001) and calcimimetic prescription (0.76; p<0.001). Conversely, only dialysis vintage was associated with a PTH < 130pg/ml (0.07; p=0.0066).
Conclusion
The use of citrate D in this cohort was not associated with a higher PTH compared to pts on acetate or HCl. The large prescription of D calcium at 1,65 mmoles/l in the citrate group may have helped to avoid low ionized calcium. Higher muscle cramps and lower magnesium were findings already reported with the use of citrate D and confirmed in this cohort. Dialysis with citrate or HCl are possible alternatives when avoiding acetate buffer is wanted. Increasing D magnesium to avoid cramps remains to be studied.
| Acetate | Citrate | HCl | p | |
| n | 162 | 186 | 176 | |
| Calcium (mmol/l) | 2,20 (2,13-2,29) | 2,19 (2.12-2,26) | 2,10 (2,12-2,27) | NS |
| Phosphate (mmol/l) | 1,31 (1,06-1,59) | 1,315 (1,13-1,55) | 1,30(1,15-1,545) | NS |
| Magnesium (mmol/l) | 0.90 (0,83-0;97) | 0.86 (0,77-0;93) | 0.88 (0,805-0,95) | < 0.001 |
| PTH (pg/ml) | 526 (324-861) | 421 (226-671) | 318 (189-582) | < 0.001 |
| 25OHD (ng/ml) | 39,5 (29,5-50,28) | 40,54 (33,37-49,67) | 39,90 (34,37-42,22) | NS |
| Bone-specific alkaline phosphatase (ng/ml) | 28.9 (20.3-49.1) | 23.0 (17.4-35.1) | 26.6 (18.1-40.7) | NS |
| Calcium dialysate (mmol/l) 1.25 1.50 1.65 1.75 | - 0.6 % 75.9 % 0 % 23.5 % | - 0.6 % 0 % 72.9 % 26.6 % | - 1.1 % 65.5 % 0 % 33.5 % |