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de Sequera P, Pérez-García R, Molina M, Álvarez-Fernández G, Muñoz-González RI, Mérida E, Camba MJ, Blázquez LA, Alcaide MP, Echarri R. Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study. Nefrologia 2022; 42:327-337. [PMID: 36210622 DOI: 10.1016/j.nefroe.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 06/16/2023] Open
Abstract
Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work we described the acute changes during an HD session with a DF with citrate instead of acetate. Now we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3 mmol/L acetate and 16 weeks with 1 mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, preHD ionic calcium and magnesium were significantly lower and PTH higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96 ± 2.33 kg/m2 when patients switched from LD with acetate to citrate. HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status.
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Affiliation(s)
- Patricia de Sequera
- Departamento de Medicina, Universidad Complutense, Madrid, Spain; Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain.
| | - Rafael Pérez-García
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Manuel Molina
- Servicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, Spain
| | | | | | - Evangelina Mérida
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria Jesús Camba
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Orense, Spain
| | - Luis Alberto Blázquez
- Servicio de Nefrología, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Maria Paz Alcaide
- Servicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Rocío Echarri
- Servicio de Nefrología, Hospital Universitario Infanta Sofia, Madrid, Spain
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Shiroud Heidari B, Bappoo N, Kelsey LJ, Davachi SM, Doyle B. Multi‐response optimization of shrinkage, clamp force, and part weight in simulated injection molding process of a dialysis micro‐filter. J Appl Polym Sci 2022. [DOI: 10.1002/app.51732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Behzad Shiroud Heidari
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth Australia
- School of Engineering The University of Western Australia Perth Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies The University of Melbourne Parkville Victoria Australia
| | - Nikhilesh Bappoo
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth Australia
- School of Engineering The University of Western Australia Perth Australia
| | - Lachlan J. Kelsey
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth Australia
- School of Engineering The University of Western Australia Perth Australia
| | - Seyed Mohammad Davachi
- Department of Biological and Chemistry Texas A&M International University Laredo Texas USA
- Department of Food Science, College of Agriculture and Life Sciences Cornell University Ithaca New York USA
| | - Barry Doyle
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth Australia
- School of Engineering The University of Western Australia Perth Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies The University of Melbourne Parkville Victoria Australia
- British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh Edinburgh UK
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de Sequera P, Pérez-García R, Molina M, Álvarez-Fernández G, Muñoz-González RI, Mérida E, Camba MJ, Blázquez LA, Alcaide MP, Echarri R. Advantages of the use of citrate over acetate as a stabilizer in hemodialysis fluid: A randomized ABC-treat study. Nefrologia 2021; 42:S0211-6995(21)00137-5. [PMID: 34391608 DOI: 10.1016/j.nefro.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Abstract
Hemodialysis (HD) with bicarbonate dialysis fluid (DF) requires the presence of an acid to prevent the precipitation of calcium and magnesium carbonate. The most used acid is acetic acid, with it several complications have been described. In a previous work, we described the acute changes during an HD session with a DF with citrate instead of acetate. Now, we report the results in the medium term, 16 weeks. It is a prospective, multicenter, crossover and randomized study, where 56 HD patients with bicarbonate three times a week were dialysed for 16 weeks with 3mmol/L acetate and 16 weeks with 1mmol/L citrate. Patients older than 18 years with a previous stay on HD of more than 3 months and with a normal functioning arteriovenous fistula were included. Epidemiological data, dialysis, bioimpedance, biochemistry before and after HD, as well as hypotensive episodes, were collected monthly. After 16 weeks of citrate treatment, pre-HD ionic calcium and magnesium were significantly lower and paratiroid hormone (PTH) higher than in the acetate period. No differences were observed in the effectiveness of dialysis. Hypotensive episodes were significantly more frequent with acetate than with citrate: 311 (14.1%) vs 238 (10.8%) sessions. The lean mass index increased by 0.96±2.33kg/m2 when patients switched from DF with acetate to citrate. HD with citrate modifies several parameters of bone mineral metabolism, not only acutely as previously described, but also in the long-term. The substitution of acetate for citrate improves hemodynamic stability, producing less hypotension and can improve nutritional status.
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Affiliation(s)
- Patricia de Sequera
- Departamento de Medicina, Universidad Complutense, Madrid, España; Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - Rafael Pérez-García
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Manuel Molina
- Servicio de Nefrología, Hospital Universitario General de Santa Lucía, Cartagena, España
| | | | | | - Evangelina Mérida
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Maria Jesús Camba
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Orense, España
| | - Luis Alberto Blázquez
- Servicio de Nefrología, Hospital General Universitario de Guadalajara, Guadalajara, España
| | - María Paz Alcaide
- Servicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Rocío Echarri
- Servicio de Nefrología, Hospital Universitario Infanta Sofia, Madrid, España
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Vida C, Carracedo J, de Sequera P, Bodega G, Pérez R, Alique M, Ramírez R. A high magnesium concentration in citrate dialysate prevents oxidative stress and damage in human monocytes in vitro. Clin Kidney J 2021; 14:1403-1411. [PMID: 33959268 PMCID: PMC8087128 DOI: 10.1093/ckj/sfaa131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of dialysis fluids (DFs) during haemodialysis has been associated with increased oxidative stress and reduced serum magnesium (Mg) levels, contributing to chronic inflammation. Since the role of Mg in modulating immune function and reducing oxidative stress has been demonstrated, the aim of this study was to characterize in vitro whether increasing the Mg concentration in DFs could protect immune cells from oxidative stress and damage. METHODS The effect of citrate [citrate dialysis fluid (CDF), 1 mM] or acetate [acetate dialysis fluid (ADF), 3 mM] dialysates with low (0.5 mM; routinely used) or high (1 mM, 1.25 mM and 2 mM) Mg concentrations was assessed in THP-1 human monocytes. The levels of reactive oxygen species (ROS), malondialdehyde (MDA) and oxidized/reduced (GSSG/GSH) glutathione were quantified under basal and inflammatory conditions (stimulation with lipopolysaccharide, LPS). RESULTS The increase of Mg in CDF resulted in a significant reduction of ROS production under basal and inflammatory conditions (extremely marked in 2 mM Mg; P < 0.001). These effects were not observed in ADF. Interestingly, in a dose-dependent manner, high Mg doses in CDF reduced oxidative stress in monocytes under both basal and inflammatory conditions. In fact, 2 mM Mg significantly decreased the levels of GSH, GSSG and MDA and the GSSG/GSH ratio in relation to 0.5 mM Mg. CONCLUSIONS CDF produces lower oxidative stress than ADF. The increase of Mg content in DFs, especially in CDF, could have a positive and protective effect in reducing oxidative stress and damage in immune cells, especially under inflammatory conditions.
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Affiliation(s)
- Carmen Vida
- Dpto de Biología de Sistemas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Julia Carracedo
- Dpto Genética, Fisiología y Microbiología (Sección Fisiología), Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Patricia de Sequera
- Sección de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
- Dpto de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Bodega
- Dpto de Biomedicina y Biotecnología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Rafael Pérez
- Sección de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Matilde Alique
- Dpto de Biología de Sistemas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, (IRYCIS), Madrid, Spain
| | - Rafael Ramírez
- Dpto de Biología de Sistemas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, (IRYCIS), Madrid, Spain
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Pérez-García R, Jaldo MT, Puerta M, Ortega M, Corchete E, de Sequera P, Martín-Navarro JA, Albalate M, Alcázar R. La hipomagnesemia en hemodiálisis se asocia a mayor riesgo de mortalidad: su relación con el líquido de diálisis. Nefrologia 2020; 40:552-562. [DOI: 10.1016/j.nefro.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/21/2020] [Accepted: 04/03/2020] [Indexed: 01/19/2023] Open
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Neri L, Bellocchio F, Kircelli F, Jirka T, Levannier M, Guillaume J, Attaf D, Barbieri C, Garbelli M, Stuard S, Canaud B, Chazot C. Long-term mortality risk associated with citric acid- and acetic acid-based bicarbonate haemodialysis: a historical cohort propensity score-matched study in a large, multicentre, population-based study. Nephrol Dial Transplant 2020; 35:1237-1244. [DOI: 10.1093/ndt/gfaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/27/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
Citric acid-based bicarbonate dialysate (CiD) is increasingly used in haemodialysis (HD) to improve haemodynamic tolerance and haemocompatibility associated with acetic acid-based bicarbonate dialysate. Safety concerns over CiD have been raised recently after a French ecological study reported higher mortality hazard in HD clinics with high CiD consumption. Therefore, we evaluated the mortality risk associated with various acidifiers (AcD, CiD) of bicarbonate dialysate.
Methods
In this multicentre, historical cohort study, we included adult incident HD patients (European, Middle-East and Africa Fresenius Medical Care network; 1 January 2014 to 31 October 2018). We recorded acidifiers of bicarbonate dialysis and dialysate composition for each dialysis session. In the primary intention-to-treat analysis, patients were assigned to the exposed group if they received CiD in >70% of sessions during the first 3 months (CiD70%), whereas the non-exposed group received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow-up.
Results
We enrolled 10 121 incident patients during the study period. Of them, 371 met the criteria for inclusion in CiD70%. After propensity score matching, mortality was 11.43 [95% confidence interval (CI) 8.86–14.75] and 12.04 (95% CI 9.44–15.35) deaths/100 person-years in the CiD0% and CiD70% groups, respectively (P = 0.80). A similar association trend was observed in the secondary analysis.
Conclusions
We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite the fact that physicians were more inclined to prescribe CiD to subjects with worse medical conditions.
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Affiliation(s)
- Luca Neri
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Francesco Bellocchio
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Fatih Kircelli
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Tomas Jirka
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | | | - Jean Guillaume
- Dialysis Unit of Tassin-Charcot, Nephrocare, Tassin-Charcot, France
| | - David Attaf
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Carlo Barbieri
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Mario Garbelli
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Stefano Stuard
- Dialysis Unit of Tassin-Charcot, Nephrocare, Tassin-Charcot, France
| | | | - Charles Chazot
- Country Medical Director, NephroCare France, Fresnes, France
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Increasing the Magnesium Concentration in Various Dialysate Solutions Differentially Modulates Oxidative Stress in a Human Monocyte Cell Line. Antioxidants (Basel) 2020; 9:antiox9040319. [PMID: 32326605 PMCID: PMC7222382 DOI: 10.3390/antiox9040319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/01/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022] Open
Abstract
Oxidative stress is exacerbated in hemodialysis patients by several factors, including the uremic environment and the use of dialysis fluids (DFs). Since magnesium (Mg) plays a key role in modulating immune function and in reducing oxidative stress, we aimed to evaluate whether increasing the Mg concentration in different DFs could protect against oxidative stress in immunocompetent cells in vitro. Effect of ADF (acetate 3 mM), CDF (citrate 1 mM), and ACDF (citrate 0.8 mM + acetate 0.3 mM) dialysates with Mg at standard (0.5 mM) or higher (1, 1.25, and 2 mM) concentrations were assessed in THP-1 monocyte cultures. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels were quantified under basal and uremic conditions (indoxyl sulfate (IS) treatment). Under uremic conditions, the three DFs with 0.5 mM Mg promoted higher ROS production and lipid damage than the control solution. However, CDF and ACDF induced lower levels of ROS and MDA, compared to that induced by ADF. High Mg concentration (1.25 and/or 2 mM) in CDF and ACDF protected against oxidative stress, indicated by reduced ROS and MDA levels compared to respective DFs with standard concentration of Mg. Increasing Mg concentrations in ADF promoted high ROS production and MDA content. Thus, an increase in Mg content in DFs has differential effects on the oxidative stress in IS-treated THP-1 cells depending on the dialysate used.
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