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

      Clinical journal of the American Society of Nephrology : CJASN

      blood, beta 2-Microglobulin, United States, Treatment Outcome, Renal Dialysis, Prospective Studies, Phosphates, Middle Aged, Male, Kinetics, Humans, Female, therapeutic use, Dialysis Solutions, Creatinine, Citric Acid, Blood Urea Nitrogen, drug effects, Blood Coagulation, Biological Markers, Bicarbonates, Anticoagulants, Ambulatory Care, Aged, Acetic Acid

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          Abstract

          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 beta-2 microglobulin in chronic dialysis units. 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. 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 beta-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 1.55 +/- 0.20 to 1.52 +/- 0.17 (P < 0.0001). Data suggest that CD use is associated with increased solute removal.

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          Journal
          10.2215/CJN.02590409
          2736688
          19661218

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