" Increased Kt/V and Decreased Beta-2 With Citrate Dialysate"
Robert Kossmann(1), Robin Callan(2), Suhail Ahmad(3)
1- Nephrophiles, Santa Fe, New Mexico: 2 - Advanced Renal Technologies, Bellevue, Washington;
3- University of Washington, Seattle, Washington
Results & Conclusions:
- Six months of Citrate Dialysate was associated with a significant increase in the dose of dialysis as measured by Kt/V urea.
- This increase was particularly significant in 19 patients whose baseline (NCD) Kt/V urea was <1.20 (1 Std. Dev. <population mean).
- In the remaining 123 patients, with mean Kt/V of 1.55, the Kt/V also increased significantly to 1.60 with Citrate Dialysate (p<0.0001).
- Associated with increase in Kt/V was a significant decrease in pre dialysis BUN and creatinine concentrations (p<0.008).
- Predialysis blood concentration of beta-2 microglobulin also declined significantly with 6 months of citrate dialysate.
- It is postulated that anticoagulation property of CD kept the dialyzer fibers and its pores open resulting in better removal of both small (urea, creatinine) and middle molecules (beta-2 microglobulin).
- CD anticoagulation caused an increase in the dose of dialysis.
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Predialysis Beta-2 Microglobulin Level |
Kt/V urea - Kt/V in All Patients (n=124) |
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Kt/V urea - Kt/V in Clotters' (n=19) |
6 Month Average Kt/V |
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Background & Purpose:
- Clotting of dialyzer often occurs during dialysis and is a major cause of reduced delivered dose of dialysis.
- Citrate Dialysate has been reported to have anticoagulant properties (Tu et al Dial & Transplant, 29; 620, 200)
- In a small number of patients over short study period, the dialysis dose increased with CD (Ahmad et al, AJKD, 35; 493, 2000)
- The effect of Citrate D Dialysate on the dose was evaluated in a larger number of patients (n=142), over longer duration (6 months) and utilizing single use dialyzers (F160 NR & F180 NR).
Methods:
- Three FMC dialysis units in New Mexico were switched from regular bicarbonate non citrate dialysate (Naturalyte® & Granuflo®, "NCD") to Citrate Dialysate (Citrasate®, "NCD") for 6 months.
- During the study dialysis time, dialyzer type, blood and dialysate flow remained unchanged.
- The dialysis dose in terms of Kt/V urea was measured monthly on NCD and CD.
- Pre-dialysis Beta-2 microglobulin (B2Mg) was also measured at the beginning and end of CD use.
- Patients with Kt/V being 1 SD below average during the 6 months of NCD were labelled as "clotters".
- Predialysis Beta-2 microglobulin was measured twice; at the end of NCD and CD use.
Acknowledgement:
- The authors wish to thank the management of Fresenius Medical Care, NA for their help and assistance with this study.