"Citrate Dialysate Decreases Aluminum Burden
in Hemodialysis (HD) Patients"
Robert Kossmann, MD1, Annette Gonzales, RN2,
Robin Callan, LLM3, Suhail Ahmad, MD4.
1Nephrophiles LLC, Santa Fe, NM,
2 Fresenius Medical Care,
Santa Fe, NM,
3Advanced Renal Technologies, Bellevue, WA,
4University of Washington, Seattle, Washington, USA
Background:
- Aluminum (Al) accumulation in dialysis
patients causes significant morbidity and
mortality. - Its dialytic removal is very limited, and the only practical treatment has been the use of
desferoxamine (DFO). - DFO carries significant risk and has limited efficacy.
- Citrate is known to have high affinity for Al, forming a water-soluble compound.
- We propose that the citrate dialysate (CD) containing 2.4 mEq/L citrate will increase dialytic removal of Al, thus reducing the plasma concentration.
Patients & Methods:
- 142 chronic HD patients dialyzing 3 times a week consented to participate in the study.
- All patients had pre-dialysis Al
concentration measured three times over
a six month period on regular (non citrate) bicarbonate dialysate. - All patients were switched to CD without changing any other treatment parameters.
- During the six months of CD the pre-dialysis plasma Al levels were also checked three times (First sample after one month on CD).
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Six Month Average Serum Aluminum Levels with Regular and Citrate Dialysate |
Six Month Average Serum Al DeclineIn Patients (N = 8)With Baseline Al Levels > 10.0 mcg/L |
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Serum Aluminum Measurements With Regular and Citrat Dialysate |
Serum AL Trends with Regular and Citrate Dialysate |
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Results:
- Pre-dialysis serum Al levels at baseline were not elevated in most patients. The average values were 6.39 + 3.87 mcg/L (mean + SD).
- During the six months of CD the average levels decreased significantly to 5.20 + 2.16 (p<0001).
- During the six months on CD the serum concentration continued to decline while during the regular dialysate the serum concentrations did not vary significantly.
- In 8 patients the Al levels at the baseline were >10 mcg/L; in these patients the significant decline in the Al level with CD was more pronounced.
- In the above sub-group the Al declined from 16.13 + 7.38 to 7.85 + 3.51 mcg/L (p<0.0007).
- All CD treatments were well tolerated without any reported events.
Summary & Conclusions:
- CD over a six month period showed continuous decline from baseline in pre-dialysis serum Al levels in 142 chronic HD patients.
- This decline was more pronounced in those patients who had higher baseline Al levels.
- It is proposed that high affinity between Al and citrate caused formation of aluminum citrate that is small in size and is highly water soluble, thus more readily dialyzable.
- The increased dialytic removal may be responsible for this decline.
- Future studies are needed to further define this
observation.