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 beta-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.

Increased dialyzer reuse with citrate dialysate.

Dialyzer reuse is limited by the clotting of blood, which blocks the fibers and reduces the membrane surface area. Clotting during treatment may also reduce dialysis efficiency and potentially decrease delivered dose, Kt/V(urea). A new dialysate containing citric acid, instead of the standard acetic acid, as the acidifying agent has become available and is associated with reduced clotting during acute dialysis treatments.