Effect of Citrate-Acidified Dialysate on Intact Parathyroid Hormone in Prevalent Hemodialysis Patients: A Matched Retrospective Cohort Study.

IF 2.1 Q2 UROLOGY & NEPHROLOGY International Journal of Nephrology and Renovascular Disease Pub Date : 2021-12-24 eCollection Date: 2021-01-01 DOI:10.2147/IJNRD.S340028

Linda H Ficociello, Meijiao Zhou, Claudy Mullon, Michael S Anger, Robert J Kossmann

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引用次数: 1

Abstract

Background: It has been proposed that substituting citrate-acidified dialysate (CAD) solutions for acetate-acidified dialysate (AAD) could improve hemodynamics and dialysis tolerance and reduce the requirement for systemic anticoagulation. Citrate chelates ionized calcium, but long-term effects of CAD use during maintenance hemodialysis have not been well studied. While many studies of the effects of CAD on serum calcium and intact parathyroid hormone (iPTH) have been short-term or have been limited by sample size, we aimed to determine if there are any long-term (i.e., 6-month) changes from pre-dialysis iPTH levels when patients are switched from AAD to CAD.

Methods: This retrospective cohort study compared various clinical parameters, including pre-dialysis iPTH and serum calcium as well as single pool Kt/V, from eligible patients who received in-center hemodialysis thrice-weekly in geographically matched CAD (n=3) or AAD clinics (n=12). CAD clinics were defined as clinics converting from AAD to CAD if >85% of the patients were prescribed CAD after implementation of CAD within the clinic.

Results: Pre-dialysis iPTH was not significantly different from baseline to 6-month follow-up within either CAD or AAD clinics. Moreover, the mean change from baseline to month 6 in iPTH between patients (n=142) in CAD clinics (-17 pg/mL) and patients (n=671) in AAD clinics (13 pg/mL) was similar (p = 0.24). Likewise, the differences in the mean change in serum calcium concentrations and dialysis adequacy (single pool Kt/V) were not significant between CAD and AAD clinics. For subgroups of patients who were never prescribed cinacalcet or calcium-based phosphate binders, there were no significantly different categorical shifts in iPTH between CAD and AAD clinics.

Conclusion: Similar trends in single pool Kt/V, iPTH, and serum calcium levels were observed in clinics that switched from AAD to CAD versus the geographically matched AAD clinics. These results support CAD as a potential alternative to AAD in hemodialysis.

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柠檬酸酸化透析液对流行血液透析患者完整甲状旁腺激素的影响:一项匹配的回顾性队列研究。

背景:有人提出用柠檬酸酸化透析液(CAD)代替醋酸酸化透析液(AAD)可以改善血液动力学和透析耐受性，降低全身抗凝的需要。柠檬酸盐螯合离子钙，但CAD在维持性血液透析期间的长期影响尚未得到很好的研究。虽然许多关于CAD对血清钙和完整甲状旁腺激素(iPTH)影响的研究都是短期的或受样本量的限制，但我们的目的是确定当患者从AAD切换到CAD时，透析前iPTH水平是否有任何长期(即6个月)的变化。方法:本回顾性队列研究比较了在地理匹配的CAD (n=3)或AAD诊所(n=12)接受每周一次中心血液透析的符合条件的患者的各种临床参数，包括透析前iPTH和血清钙以及单池Kt/V。CAD诊所被定义为从AAD向CAD转换的诊所，如果>85%的患者在诊所内实施CAD后使用CAD处方。结果:在CAD或AAD诊所，透析前iPTH与基线至6个月随访无显著差异。此外，从基线到第6个月，CAD诊所患者(n=142)的iPTH (-17 pg/mL)和AAD诊所患者(n=671)的iPTH (13 pg/mL)的平均变化相似(p = 0.24)。同样，在CAD和AAD诊所之间，血清钙浓度和透析充分性(单池Kt/V)的平均变化差异也不显著。对于从未开过cinacalcet或钙基磷酸盐结合剂的患者亚组，CAD和AAD诊所之间iPTH的分类变化没有显著差异。结论:从AAD转为CAD的诊所与地理位置匹配的AAD诊所在单池Kt/V、iPTH和血清钙水平上观察到相似的趋势。这些结果支持CAD作为血液透析中AAD的潜在替代品。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Nephrology and Renovascular Disease UROLOGY & NEPHROLOGY-

CiteScore

3.90

自引率

5.00%

发文量

审稿时长

16 weeks

期刊介绍： International Journal of Nephrology and Renovascular Disease is an international, peer-reviewed, open-access journal focusing on the pathophysiology of the kidney and vascular supply. Epidemiology, screening, diagnosis, and treatment interventions are covered as well as basic science, biochemical and immunological studies. In particular, emphasis will be given to: -Chronic kidney disease- Complications of renovascular disease- Imaging techniques- Renal hypertension- Renal cancer- Treatment including pharmacological and transplantation- Dialysis and treatment of complications of dialysis and renal disease- Quality of Life- Patient satisfaction and preference- Health economic evaluations. The journal welcomes submitted papers covering original research, basic science, clinical studies, reviews & evaluations, guidelines, expert opinion and commentary, case reports and extended reports. The main focus of the journal will be to publish research and clinical results in humans but preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies and interventions.