Kidney Research and Clinical Practice 2019 Mar; 38(1): 100-107
Conversion from acetate dialysate to citrate dialysate in a central delivery system for maintenance hemodialysis patients
Eun ji Park1, Su Woong Jung1, Da Rae Kim2, Jin Sug Kim1, Tae Won Lee1, Chun Gyoo Ihm1, Kyung Hwan Jeong1
1Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea, 2Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
Correspondence to: Kyung Hwan Jeong, Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. E-mail:
Received: June 7, 2018; Revised: November 12, 2018; Accepted: November 13, 2018; Published online: March 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

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Background: The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters.
Methods: We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period.
Results: Patients were 60.5 ± 14.7 years old, of whom 62.7% were male. Patients required less heparin when receiving CD (AD period: 1,129 ± 1,033 IU/session vs. CD period: 787 ± 755 IU/session, P < 0.001). After the CD period (ΔCD), pre-dialysis total CO2 increased to 1.21 ± 2.80 mmol/L, compared to -2.44 ± 2.96 mmol/L (P < 0.001) after the AD period (ΔAD). After the CD period, concentrations of iPTH (ΔAD: 73.04 ± 216.34 pg/mL vs. ΔCD: -106.66 ± 251.79 pg/mL, P < 0.001) and CaxP (ΔAD: 4.32 ± 16.63 mg2/dL2 vs. ΔCD: -4.67 ± 15.27 mg2/dL2, P = 0.015) decreased. While hsCRP levels decreased after the CD period (ΔAD: 0.07 ± 4.09 mg/L vs. ΔCD: -0.75 ± 4.56 mg/L, P = 0.705), the change was statistically insignificant. URR remained above clinical guideline of 65% after both periods (ΔAD: 72.33 ± 6.92% vs. ΔCD period: 69.20 ± 4.49%, P = 0.046).
Conclusion: Our study confirmed that the use of CD in CDS required lower heparin doses compared to the use of AD. The use of CD also provided a more stable acid-base status.
Keywords: Acetates, Citric acid, Hemodialysis, Heparin


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