Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study

Background and objectives: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect. This study examines the effect of CD on dialysis efficiency, measured as eKt/Vurea, and predialysis concentrations of BUN, creatinine, phosphate, and -2 microglobulin in chronic dialysis units. Design, settings, participants, & measurements: Three outpatient chronic hemodialysis units with 142 patients were switched to CD for 6 mo. Using each patient’s prior 6 mo on regular bicarbonate dialysate acidified by acetate (AD) as control, eKt/Vurea was compared with that of CD. Follow-up data for 7 mo after the study were collected from about one-half of the participants remaining on CD and the others returned to AD. Results: eKt/Vurea, increased (P < 0.0001) from pre-CD value of 1.51 0.01 to 1.57 0.01 with CD. During CD use -2 microglobulin levels declined (P 0.0001) from 28.1 10.0 to 25.9 10.0. Similarly, the concentrations of BUN, creatinine, and phosphate also decreased on CD (P < 0.008). In the poststudy period, eKt/Vurea for the patients staying on CD remained unchanged at 1.60 0.17 versus 1.59 0.18 (P NS), whereas in those returning to AD the eKt/Vurea decreased from 1.5