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Broseta JJ, Roca M, Rodríguez-Espinosa D, López-Romero LC, Gómez-Bori A, Cuadrado-Payán E, Devesa-Such R, Soldevila A, Bea-Granell S, Sánchez-Pérez P, Hernández-Jaras J. Impact of Acetate versus Citrate Dialysates on Intermediary Metabolism-A Targeted Metabolomics Approach. Int J Mol Sci 2022; 23:ijms231911693. [PMID: 36232995 PMCID: PMC9569767 DOI: 10.3390/ijms231911693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Acetate is widely used as a dialysate buffer to avoid the precipitation of bicarbonate salts. However, even at low concentrations that wouldn’t surpass the metabolic capacity of the Krebs tricarboxylic acid (TCA) cycle, other metabolic routes are activated, leading to undesirable clinical consequences by poorly understood mechanisms. This study aims to add information that could biologically explain the clinical improvements found in patients using citrate dialysate. A unicentric, cross-over, prospective targeted metabolomics study was designed to analyze the differences between two dialysates, one containing 4 mmol/L of acetate (AD) and the other 1 mmol/L of citrate (CD). Fifteen metabolites were studied to investigate changes induced in the TCA cycle, glycolysis, anaerobic metabolism, ketone bodies, and triglyceride and aminoacidic metabolism. Twenty-one patients completed the study. Citrate increased during the dialysis sessions when CD was used, without surpassing normal values. Other differences found in the next TCA cycle steps showed an increased substrate accumulation when using AD. While lactate decreased, pyruvate remained stable, and ketogenesis was boosted during dialysis. Acetylcarnitine and myo-inositol were reduced during dialysis, while glycerol remained constant. Lastly, glutamate and glutarate decreased due to the inhibition of amino acidic degradation. This study raises new hypotheses that need further investigation to understand better the biochemical processes that dialysis and the different dialysate buffers induce in the patient’s metabolism.
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Affiliation(s)
- José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
- Correspondence: ; Tel.: +34-932275498
| | - Marta Roca
- Analytical Unit Platform, Medical Research Institute Hospital La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Diana Rodríguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | | | - Aina Gómez-Bori
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Elena Cuadrado-Payán
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Ramón Devesa-Such
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Amparo Soldevila
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Sergio Bea-Granell
- Department of Nephrology, Consorci Hospital General Universitari de València, 46014 Valencia, Spain
| | - Pilar Sánchez-Pérez
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Julio Hernández-Jaras
- Department of Nephrology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
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2
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Marcelli D, Basile C. Has time come to replace the residual acetate with citrate in the dialysis fluid? J Nephrol 2021; 35:87-90. [PMID: 33661506 DOI: 10.1007/s40620-021-00991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Carlo Basile
- Division of Nephrology, Clinical Research Branch, Miulli General Hospital, Acquaviva delle Fonti, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
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Ureña-Torres P, Bieber B, Guebre-Egziabher F, Ossman R, Jadoul M, Inaba M, Robinson BM, Port F, Jacquelinet C, Combe C. Citric Acid-Containing Dialysate and Survival Rate in the Dialysis Outcomes and Practice Patterns Study. KIDNEY360 2021; 2:666-673. [PMID: 35373053 PMCID: PMC8791321 DOI: 10.34067/kid.0006182020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
Background Metabolic acidosis is a common threat for patients on hemodialysis, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic, citric, or hydrochloric acid are added. The first two are metabolized to bicarbonate, mostly by the liver. Citric acid-containing dialysate might improve dialysis efficiency, anticoagulation, calcification propensity score, and intradialytic hemodynamic stability. However, a recent report from the French dialysis registry suggested this dialysate increases mortality risk. This prompted us to assess whether citric acid-containing bicarbonate-based dialysate was associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012-2017). Cox regression was used to model the association between baseline bicarbonate dialysate containing citric acid versus not containing citric acid and mortality among DOPPS countries and phases where citric acid-containing dialysate was used. Results Citric acid-containing dialysate was most commonly used in Japan, Italy, and Belgium (25%, 25%, 21% and of patients who were DOPPS phase 6, respectively) and used in <10% of patients in other countries. Among 11,306 patients in DOPPS country and phases with at least 15 patients using citric acid-containing dialysate, patient demographics, comorbidities, and laboratories were similar among patients using (14%) versus not using (86%) citric acid-containing dialysate. After accounting for case mix, we did not observe a directional association between citric acid-containing dialysate use (any versus none) and mortality (HR, 1.14; 95% CI, 0.97 to 1.34), nor did we find evidence of a dose-dependent relationship when parameterizing the citric acid concentration in the dialysate as 1, 2, and 3+ mEq/L. Conclusions The use of citric acid-containing dialysate was not associated with greater risk of all-cause mortality in patients on hemodialysis participating in DOPPS. Clinical indications for the use of citric acid-containing dialysate deserve further investigation.
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Affiliation(s)
- Pablo Ureña-Torres
- Department of Dialysis, Association pour l'Utilisation du Rein Artificiel en Ile de France, Nord Saint Ouen, Saint Ouen, France,Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Brian Bieber
- Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Fitsum Guebre-Egziabher
- Department of Nephrology, Hypertension and Dialysis, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Rim Ossman
- Department of Dialysis, Association pour l'Utilisation du Rein Artificiel en Ile de France, Nord Saint Ouen, Saint Ouen, France
| | - Michel Jadoul
- Department of Nephrology and Dialysis. Universitary Clinics Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Bruce M. Robinson
- Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Friedrich Port
- Dialysis Outcomes and Practice Patterns Study (DOPPS) Coordinating Center, Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Christian Combe
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Centre Hospitalo-Universitaire de Bordeaux and Institute National de la Santé et de la Recherche Médicale U1026, Université de Bordeaux, Bordeaux, France
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Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review. Br J Anaesth 2020; 125:693-703. [DOI: 10.1016/j.bja.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/29/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023] Open
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Lorenz G, Mayer CC, Bachmann Q, Stryeck S, Braunisch MC, Haller B, Carbajo-Lozoya J, Schmidt A, Witthauer S, Abuzahu J, Kemmner S, Angermann S, Koneru N, Wassertheurer S, Bieber R, Heemann U, Madl T, Pasch A, Schmaderer C. Acetate-free, citrate-acidified bicarbonate dialysis improves serum calcification propensity-a preliminary study. Nephrol Dial Transplant 2019; 33:2043-2051. [PMID: 29860419 DOI: 10.1093/ndt/gfy134] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 12/24/2022] Open
Abstract
Background A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity. Methods T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients. In all, 44 were then switched back to acetate. Partial correlation was used to study associations of changing T50 and changing covariates. Linear mixed effect models were built to assess the association of CiaHD and covariates with changing T50. Results A significant intra-individual increase of serum calcification resilience was found after 3 months on CiaHD (206 ± 56 to 242 ± 56 min; P < 0.001), but not after switching back to acetate (252 ± 63 to 243 ± 64 min; n = 44; P = 0.29). CiaHD, Δ serum phosphate and Δ albumin but not Δ ionized calcium and magnesium were the strongest determinants of changing T50. Beneath T50, only serum albumin but not phosphate changed significantly during 3 months of CiaHD. Conclusion CiaHD dialysis favourably affected calcification propensity as measured by the T50 test. Whether this treatment, beyond established phosphate-directed treatments, has the potential to sustainably tip the balance towards a more anti-calcific serum milieu needs to be further investigated.
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Affiliation(s)
- Georg Lorenz
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christopher C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Quirin Bachmann
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sarah Stryeck
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Matthias C Braunisch
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technical University Munich, Germany
| | - Javier Carbajo-Lozoya
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alina Schmidt
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Simon Witthauer
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jasmin Abuzahu
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Susanne Angermann
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Naresh Koneru
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Siegfried Wassertheurer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | | | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria.,BioTechMed, Graz, Austria
| | | | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Dao M, Touam M, Joly D, Mercadal L. Nouveaux dialysats : quel acide dans le bain de dialyse ? Nephrol Ther 2019; 15 Suppl 1:S91-S97. [DOI: 10.1016/j.nephro.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Smith WB, Gibson S, Newman GE, Hendon KS, Askelson M, Zhao J, Hantash J, Flanagan B, Larkin JW, Usvyat LA, Thadhani RI, Maddux FW. The dynamics of the metabolism of acetate and bicarbonate associated with use of hemodialysates in the ABChD trial: a phase IV, prospective, single center, single blind, randomized, cross-over, two week investigation. BMC Nephrol 2017; 18:273. [PMID: 28851317 PMCID: PMC5576126 DOI: 10.1186/s12882-017-0683-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 08/04/2017] [Indexed: 11/17/2022] Open
Abstract
Background In the United States, hemodialysis (HD) is generally performed via a bicarbonate dialysate. It is not known if small amounts of acid used in dialysate to buffer the bicarbonate can meaningfully contribute to overall buffering administered during HD. We aimed to investigate the metabolism of acetate with use of two different acid buffer concentrates and determine if it effects blood bicarbonate concentrations in HD patients. Methods The Acid-Base Composition with use of hemoDialysates (ABChD) trial was a Phase IV, prospective, single blind, randomized, cross-over, 2 week investigation of peridialytic dynamics of acetate and bicarbonate associated with use of acid buffer concentrates. Eleven prevalent HD patients participated from November 2014 to February 2015. Patients received two HD treatments, with NaturaLyte® and GranuFlo® acid concentrates containing 4 and 8 mEq/L of acetate, respectively. Dialysate order was chosen in a random fashion. The endpoint was to characterize the dynamics of acetate received and metabolized during hemodialysis, and how it effects overall bicarbonate concentrations in the blood and dialysate. Acetate and bicarbonate concentrations were assessed before, at 8 time points during, and 6 time points after the completion of HD. Results Data from 20 HD treatments for 11 patients (10 NaturaLyte® and 10 GranuFlo®) was analyzed. Cumulative trajectories of arterialized acetate were unique between NaturaLyte® and GranuFlo® (p = 0.003), yet individual time points demonstrated overlap without remarkable differences. Arterialized and venous blood bicarbonate concentrations were similar at HD initiation, but by 240 min into dialysis, mean arterialized bicarbonate concentrations were 30.2 (SD ± 4.16) mEq/L in GranuFlo® and 28.8 (SD ± 4.26) mEq/L in NaturaLyte®. Regardless of acid buffer concentrate, arterial blood bicarbonate was primarily dictated by the prescribed bicarbonate level. Subjects tolerated HD with both acid buffer concentrates without experiencing any related adverse events. Conclusions A small fraction of acetate was delivered to HD patients with use of NaturaLyte® and GranuFlo® acid buffers; the majority of acetate received was observed to be rapidly metabolized and cleared from the circulation. Blood bicarbonate concentrations appear to be determined mainly by the prescribed concentration of bicarbonate. Trial registration This trial was registered on ClinicalTrials.gov on 11 Dec 2014 (NCT02334267). Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0683-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- William B Smith
- Volunteer Research Group and New Orleans Center for Clinical Research at the University of Tennessee Medical Center, 1928 Alcoa Highway, Suite 107, Knoxville, TN, 37920, USA.
| | - Sandy Gibson
- Volunteer Research Group and New Orleans Center for Clinical Research at the University of Tennessee Medical Center, 1928 Alcoa Highway, Suite 107, Knoxville, TN, 37920, USA
| | - George E Newman
- Knoxville Kidney Center, PLLC, 320 Park 40 N Blvd, Knoxville, TN, 37923, USA
| | - Kendra S Hendon
- Knoxville Kidney Center, PLLC, 320 Park 40 N Blvd, Knoxville, TN, 37923, USA
| | | | - James Zhao
- EDETEK, 500 College Road East, Suite 200, Princeton, NJ, 08540, USA
| | - Jamil Hantash
- Tandem Labs, 115 Silvia Street, West Trenton, NJ, 08628, USA
| | - Brigid Flanagan
- Frenova Renal Research, 920 Winter Street, Waltham, MA, 02451, USA
| | - John W Larkin
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | - Len A Usvyat
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | - Ravi I Thadhani
- Massachusetts General Hospital Division of Nephrology, 55 Fruit Street #1008, Boston, MA, 02114, USA
| | - Franklin W Maddux
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
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8
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Lew SQ, Kohn OF, Cheng YL, Kjellstrand CM, Ing TS. Three-Stream, Bicarbonate-Based Hemodialysis Solution Delivery System Revisited: With an Emphasis on Some Aspects of Acid-Base Principles. Artif Organs 2017; 41:509-518. [PMID: 28574225 DOI: 10.1111/aor.12947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/22/2017] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Abstract
Hemodialysis patients can acquire buffer base (i.e., bicarbonate and buffer base equivalents of certain organic anions) from the acid and base concentrates of a three-stream, dual-concentrate, bicarbonate-based, dialysis solution delivery machine. The differences between dialysis fluid concentrate systems containing acetic acid versus sodium diacetate in the amount of potential buffering power were reviewed. Any organic anion such as acetate, citrate, or lactate (unless when combined with hydrogen) delivered to the body has the potential of being converted to bicarbonate. The prescribing physician aware of the role that organic anions in the concentrates can play in providing buffering power to the final dialysis fluid, will have a better knowledge of the amount of bicarbonate and bicarbonate precursors delivered to the patient.
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Affiliation(s)
- Susie Q Lew
- Department of Medicine, George Washington University, Washington, DC
| | - Orly F Kohn
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Yuk-Lun Cheng
- Department of Medicine and ICU, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Carl M Kjellstrand
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Kato A, Takita T, Furuhashi M. Hypersensitivity reactions to acetate in the bicarbonate dialysate in a patient undergoing pre-dilution online hemodiafiltration. CEN Case Rep 2017; 5:31-33. [PMID: 28509160 DOI: 10.1007/s13730-015-0185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022] Open
Abstract
A 63-year-old male patient first experienced recurrent hypotensive episode during the dialysis session just after switching the mode from hemodialysis to online hemodiafiltration (OL-HDF) with infusion in pre-dilution of the bicarbonate dialysate containing 9.2 mEq/L of acetate. Peripheral eosinophil count and serum IgE were both elevated to 16,440/μL and 2000 IU/L. The reactions promptly dissolved with substitution of acetate-free solution. This case illustrated that pre-dilution OL-HDF can induce an occult hypersensitivity to acetate in the standard bicarbonate dialysate.
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Affiliation(s)
- Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Takako Takita
- Division of Nephrology, Maruyama Hospital, Hamamatsu, Japan
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Abstract
The optimal approach to managing acid-base balance is less well defined for patients receiving hemodialysis than for those receiving peritoneal dialysis. Interventional studies in hemodialysis have been limited and inconsistent in their findings, whereas more compelling data are available from interventional studies in peritoneal dialysis. Both high and low serum bicarbonate levels associate with an increased risk of mortality in patients receiving hemodialysis, but high values are a marker for poor nutrition and comorbidity and are often highly variable from month to month. Measurement of pH would likely provide useful additional data. Concern has arisen regarding high-bicarbonate dialysate and dialysis-induced alkalemia, but whether these truly cause harm remains to be determined. The available evidence is insufficient for determining the optimal target for therapy at this time.
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Affiliation(s)
- Matthew K Abramowitz
- Division of Nephrology, Department of Medicine, and
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Weinberg L, Collins N, Van Mourik K, Tan C, Bellomo R. Plasma-Lyte 148: A clinical review. World J Crit Care Med 2016; 5:235-250. [PMID: 27896148 PMCID: PMC5109922 DOI: 10.5492/wjccm.v5.i4.235] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/06/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.
METHODS We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers”“acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text.
RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.
CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.
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Ortiz PDS, Ramón MA, Pérez-García R, Prats EC, Cobo PA, Arroyo RA, Díaz MO, Carretero MP. Acute effect of citrate bath on postdialysis alkalaemia. Nefrologia 2015; 35:164-71. [PMID: 26300510 DOI: 10.1016/j.nefro.2014.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The correction of metabolic acidosis caused by renal failure is achieved by adding bicarbonate during dialysis. In order to avoid the precipitation of calcium carbonate and magnesium carbonate that takes place in the dialysis fluid (DF) when adding bicarbonate, it is necessary to add an acid, usually acetate, which is not free of side effects. Thus, citrate appears as an advantageous alternative to acetate, despite the fact that its acute effects are not accurately known. OBJECTIVE To assess the acute effect of a dialysis fluid containing citrate instead of acetate on acid-base balance and calcium-phosphorus metabolism parameters. MATERIAL AND METHODS A prospective crossover study was conducted with twenty-four patients (15 male subjects and 9 female subjects). All patients underwent dialysis with AK-200-Ultra-S monitor with SoftPac® dialysis fluid, made with 3 mmol/L of acetate and SelectBag Citrate®, with 1 mmol/L of citrate and free of acetate. The following were measured before and after dialysis: venous blood gas monitoring, calcium (Ca), ionic calcium (Cai), phosphorus (P) and parathyroid hormone (PTH). RESULTS Differences (p<0.05) were found when using the citrate bath (C) compared to acetate (A) in the postdialysis values of: pH, C: 7.43 (0.04) vs. A: 7.47 (0.05); bicarbonate, C: 24.7 (2.7) vs. A: 27.3 (2.1) mmol/L; base excess (BEecf), C: 0.4 (3.1) vs. A: 3.7 (2.4) mmol/L; corrected calcium (Cac), C: 9.8 (0.8) vs. A: 10.1 (0.7) mg/dL; and Cai, C: 1.16 (0.05) vs. A: 1.27 (0.06) mmol/L. No differences were found in either of the parameters measured before dialysis. CONCLUSION Dialysis with citrate provides better control of postdialysis acid-base balance, decreases/avoids postdialysis alkalaemia, and lowers the increase in Cac and Cai. This finding is of special interest in patients with predisposing factors for arrhythmia and patients with respiratory failure, carbon dioxide retention, calcifications and advanced liver disease.
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Affiliation(s)
| | | | - Rafael Pérez-García
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España)
| | | | | | | | - Maira Ortega Díaz
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid (España)
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Tiranathanagul K, Tangvoraphonkchai K, Srisawat N, Susantitaphong P, Tungsanga K, Praditpornsilpa K, Eiam-Ong S. Acute intradialytic cardiac function and inflammatory cytokine changes during high-efficiency online hemodiafiltration with acetate-free and standard dialysis solutions. Ther Apher Dial 2014; 19:250-8. [PMID: 25545821 DOI: 10.1111/1744-9987.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/01/2014] [Indexed: 11/28/2022]
Abstract
Acetate in standard acetate-containing bicarbonate (AC) dialysis fluid could induce peripheral vasodilatation, suppression of myocardial function, and inflammatory cytokine production, resulting in intradialytic hypotension in conventional hemodialysis (HD) patients. Online hemodiafiltration (HDF) provides superior hemodynamic stability over HD. The potentially additive hemodynamic benefits of the novel acetate-free bicarbonate (AF) dialysis fluid in online HDF have never been explored before. The present randomized, double-blind, crossover study was conducted in 22 online HDF patients to investigate the impact of AF dialysis fluid on hemodynamic and cytokine changes compared with AC dialysis fluid in online HDF. The results demonstrated the comparable changes of arterial pressure between AF and AC online HDF. During the study periods, the incidences of composite intradialytic hypotension and other adverse events were not different. The baseline and hourly changes of cardiac index, cardiac output, and peripheral vascular resistance during dialysis were comparable (P=0.534, 0.199, and 0.641, respectively). The percent reductions of NT-proBNP and cTnT were not significantly different (72.6 ± 12.3 vs. 72.6 ± 12.8%, P=0.99 and 35.2 ± 12.8 vs. 36.7 ± 12.0%, P=0.51). The changes of all pro-inflammatory cytokines (IL-2β, IL-6, IL-8, and TNF-α) and anti-inflammatory cytokine (IL-10) during dialysis were comparable between both groups. In conclusion, AF dialysis solution does not offer additional hemodynamic benefit for stable online HDF patients. The hemodynamic stability provided by online HDF might protect the adverse effects of acetate.
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Affiliation(s)
- Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamonwan Tangvoraphonkchai
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Sánchez-Canel JJ, Hernández-Jaras J, Pons-Prades R. A randomized controlled study on the effects of acetate-free biofiltration on organic anions and acid-base balance in hemodialysis patients. Ther Apher Dial 2014; 19:63-72. [PMID: 25256567 DOI: 10.1111/1744-9987.12180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Metabolic acidosis correction is achieved by the transfer of bicarbonate and other buffer anions in dialysis. The aim of this study was to evaluate changes in the main anions of intermediary metabolism on standard hemodiafiltration (HDF) and on acetate-free biofiltration (AFB). A prospective, in-center, crossover study was carried out with 22 patients on maintenance dialysis. Patients were randomly assigned to start with 12 successive sessions of standard HDF with bicarbonate (34 mmol/L) and acetate dialysate (3 mmol/L) or 12 successive sessions of AFB without base in the dialysate. Acetate increased significantly during the standard HDF session from 0.078 ± 0.062 mmol/L to 0.156 ± 0.128 mmol/L (P < 0.05) and remained unchanged at 0.044 ± 0.034 mmol and 0.055 ± 0.028 mmol/L in AFB modality. Differences in the acetate levels were observed at two hours (P < 0.005), at the end (P < 0.005) and thirty minutes after the session between HDF and AFB (P < 0.05). There were significantly more patients above the normal range in HDF group than AFB group (68.1% vs 4.5% P < 0.005) postdialysis and 30 minutes later. Serum lactate and pyruvate concentrations decreased during the sessions without differences between modalities. Citrate decreased only in the AFB group (P < 0.05). Acetoacetate and betahydroxybutyrate increased in both modalities, but the highest betahydroxybutyrate values were detected in HDF (P < 0.05). The sum of postdialysis unusual measured organic anions (OA) were higher in HDF compared to AFB (P < 0.05). AFB achieves an optimal control of acid-base equilibrium through a bicarbonate substitution fluid. It also prevents hyperacetatemia and restores internal homeostasis with less production of intermediary metabolites.
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15
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Hofmann-Kiefer KF, Chappell D, Kammerer T, Jacob M, Paptistella M, Conzen P, Rehm M. Influence of an acetate- and a lactate-based balanced infusion solution on acid base physiology and hemodynamics: an observational pilot study. Eur J Med Res 2012; 17:21. [PMID: 22769740 PMCID: PMC3479046 DOI: 10.1186/2047-783x-17-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 06/04/2012] [Indexed: 12/14/2022] Open
Abstract
Background The current pilot study compares the impact of an intravenous infusion of Ringer’s lactate to an acetate-based solution with regard to acid–base balance. The study design included the variables of the Stewart approach and focused on the effective strong ion difference. Because adverse hemodynamic effects have been reported when using acetate buffered solutions in hemodialysis, hemodynamics were also evaluated. Methods Twenty-four women who had undergone abdominal gynecologic surgery and who had received either Ringer’s lactate (Strong Ion Difference 28 mmol/L; n = 12) or an acetate-based solution (Strong Ion Difference 36.8 mmol/L; n = 12) according to an established clinical protocol and its precursor were included in the investigation. After induction of general anesthesia, a set of acid–base variables, hemodynamic values and serum electrolytes was measured three times during the next 120 minutes. Results Patients received a mean dose of 4,054 ± 450 ml of either one or the other of the solutions. In terms of mean arterial blood pressure and norepinephrine requirements there were no differences to observe between the study groups. pH and serum HCO3- concentration decreased slightly but significantly only with Ringer’s lactate. In addition, the acetate-based solution kept the plasma effective strong ion difference more stable than Ringer’s lactate. Conclusions Both of the solutions provided hemodynamic stability. Concerning consistency of acid base parameters none of the solutions seemed to be inferior, either. Whether the slight advantages observed for the acetate-buffered solution in terms of stability of pH and plasma HCO3- are clinically relevant, needs to be investigated in a larger randomized controlled trial.
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16
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Petitclerc T, Diab R, Le Roy F, Mercadal L, Hmida J. [Acetate-free hemodialysis: what does it mean?]. Nephrol Ther 2010; 7:92-8. [PMID: 21130720 DOI: 10.1016/j.nephro.2010.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 10/20/2010] [Accepted: 10/21/2010] [Indexed: 11/18/2022]
Abstract
Substituting bicarbonate by acetate in dialysis fluids has been proposed for avoiding precipitation of calcium and magnesium carbonates. However, acetate hemodialysis has been abandoned because of deleterious effects of acetate. Conventional bicarbonate hemodialysis is not totally acetate-free, because 3 to 7 mEq/l of acetic acid are added to the dialysate. Acetate-free hemodialysis is possible with another acid (chlorhydric acid or citric acid) or without acid by using some techniques of low-efficiency hemodiafiltration, as acetate-free biofiltration, which avoids the deleterious effect of blood acidification into the dialyzer. In this paper, advantages and disadvantages of different techniques of acetate-free hemodialysis are discussed.
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Affiliation(s)
- Thierry Petitclerc
- Département de biophysique, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, 75013 Paris, France.
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17
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Selby NM, Fluck RJ, Taal MW, McIntyre CW. Effects of acetate-free double-chamber hemodiafiltration and standard dialysis on systemic hemodynamics and troponin T levels. ASAIO J 2006; 52:62-9. [PMID: 16436892 DOI: 10.1097/01.mat.0000189725.93808.58] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Using acetate as a buffer during hemodialysis is recognized to predispose to intradialytic hypotension; however, bicarbonate-based dialysis is not acetate free. Paired hemodiafiltration (PHF) is a novel online acetate-free technique. We investigated whether PHF is capable of abrogating the changes in systemic hemodynamics and troponin T (cTnT) seen with conventional hemodialysis. Twelve patients entered a randomized crossover study. Blood pressure (BP) and a full range of hemodynamic variables were measured throughout PHF and standard dialysis using continuous pulse wave analysis. We also measured predialysis cTnT in 54 stable and unstable dialysis patients. BP was lower during PHF but without increased instability. Stoke volume and cardiac output declined progressively during both treatments but to a much lesser extent during PHF (p = 0.003, p < 0.0001 respectively), whereas peripheral resistance rose to a larger degree during hemodialysis (p < 0.0001). cTnT levels were lower before PHF as compared with hemodialysis (p = 0.023), with levels falling after PHF and rising after hemodialysis (p < 0.0001). In the supplementary patient group, predialysis median serum cTnT was higher in the unstable patients (p = 0.0001). This study demonstrates that PHF (without exposure to acetate) is associated with less deterioration in systemic hemodynamics, maintenance of BP, and less suppression of myocardial contractility as compared with bicarbonate dialysis.
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Affiliation(s)
- Nicholas M Selby
- Department of Renal Medicine, Derby City Hospital, Uttoxeter Road, Derby DE22 3NE, UK
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Pizzarelli F, Cerrai T, Dattolo P, Ferro G. On-line haemodiafiltration with and without acetate. Nephrol Dial Transplant 2006; 21:1648-51. [PMID: 16464887 DOI: 10.1093/ndt/gfk093] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients on on-line convective treatments, given the considerable quantity of dialysis fluid re-infused, the small amount of acetate present in bicarbonate dialysis fluid as a pH stabilizing factor may allow a significant transfer of that anion to the patient, possibly inducing cytokine activation. METHODS To verify this hypothesis, we performed on-line haemodiafiltration (OL-HDF) with (3 mmol/l) and without acetate in dialysis fluid in a cross-over randomized order on 12 prevalent patients. RESULTS In comparison with the pre-treatment values, plasma acetate levels were unchanged during and after acetate-free OL-HDF, while they were 5-6 times higher in the course of OL-HDF containing acetate in dialysis fluid; plasma acetate levels returned to basal values 2 h after the end of the procedure. The total increase of bases in the patient attributable to acetate was 36%. Plasma bicarbonate values at the end of treatment were significantly lower in treatments without acetate, as compared to those with acetate. Interleukin-6 plasma levels were super-imposable at the beginning and in the course of the two methods compared, but there was a tendency towards a greater increase at an interval of 2 h following OL-HDF with acetate. CONCLUSIONS Our preliminary results confirm the assumption that body gain of acetate is particularly high in convective treatments, while acetate-free OL-HDF slows down acetate burden. Clinical advantages due to these effects should be evaluated in properly designed prospective studies.
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Abstract
Hemodiafiltration appears to be the most effective technique of renal replacement therapy but several drawbacks are not counterbalanced by significant advantages. Although optimal transfer for both small and middle molecules can be achieved, there is no difference in mortality risk between HDF and HD patients. The infusion of a large amount of dialysate containing residual acetate of 2-7 mmol/l could lead to impaired cardiac contractile functions and carbonyl stress whereas loss of amino acids and water-soluble vitamins along with high UF rate could lead to malnutrition. Moreover, as substitution fluid is prepared on-line, contaminated fluid could be inadvertently infused to patients. Stringent maintenance rules are required for the production of sterile and non-pyrogenic dialysis solutions. Finally, daily hemodialysis could be the most promising mode of renal replacement therapy since it leads to a more stable 'milieu interieur' than other techniques whatever the mode of solutes removal when performed three times a week.
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Affiliation(s)
- Nguyen Khoa Man
- National Institute of Health and Medical Research, INSERM U507, Department of Nephrology, Hospital Necker, Paris, France.
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