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Abstract: TH-PO267

Dialysate Buffer in Hemodialysis: Effect of Practice Patterns on Serum PTH

Session Information

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.

 AcetateCitrateHClp
n162186176 
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 %