虽然柠檬酸透析液(CIDi)被认为是安全的,使用较高透析液体积的透析模式,比如血液透析滤过(HDF),可能会使患者暴露于更高的柠檬酸盐负荷,从而增加并发症的风险。我们调查了不同透析方式患者Cidi与标准透析液(StDi)相比的残留风险及其对透析剂量的影响。
在一项多中心随机交叉研究中,92名透析患者(HDF稀释后:n=44,HDF稀释前:n=26,血液透析:n=25)用每种透析液(StDi和Cidi)治疗4周。低钙血症(离子钙≤0.9mmol/L),碱中毒(pH≥7.55),后处理碳酸氢盐≥32mmol/L,预处理碳酸氢盐≥27mmol/L,我们将透析期间的透析内事件(IEs)和不良事件(AE)作为主要终点.次要目标是透析疗效,即尿素的剂量和去除率,肌酐,磷酸盐和β-2-微球蛋白。
透析后碳酸氢盐(>32mmol/L)的过度校正在CIDi中频率较低(P=0.008)。其他预定义的钙和酸碱干扰没有变化。IE没有显著差异。然而,更多的患者出现了不良事件,如疲劳,使用Cidi的肌肉痉挛或疼痛(StDi:41对Cidi:55名患者,P=0.02),特别是在接触的前2周。两种透析液的透析功效相当。
可以证实,Cidi与严重的钙和酸碱障碍的发展无关,即使使用更高柠檬酸盐负荷的透析方式。然而,需要改进CIDi组成以使AE最小化。
Although citrate dialysate (CiDi) is regarded to be safe, dialysis modalities using higher dialysate volumes, like haemodiafiltration (HDF), may expose patients to higher citrate load and thus increase the risk of complications. We investigated the residual risk of CiDi compared with standard dialysate (StDi) in patients on different dialysis modalities and its effect on dialysis dose.
In a multicentre randomized crossover
study, 92 dialysis patients (HDF post-dilution: n = 44, HDF pre-dilution: n = 26, haemodialysis: n = 25) were treated for 4 weeks with each dialysate (StDi and CiDi). Hypocalcaemia (ionized calcium ≤0.9 mmol/L), alkalosis (pH ≥7.55), post-treatment bicarbonate ≥32 mmol/L, pre-treatment bicarbonate ≥27 mmol/L, intra-dialytic events (IEs) and adverse events (AEs) between dialysis sessions were investigated as primary end points. The secondary objective was dialysis efficacy, i.e. dose and removal ratios of urea, creatinine, phosphate and β-2-microglobulin.
Post-dialysis overcorrection of bicarbonate (>32 mmol/L) was less frequent with CiDi (P = 0.008). Other predefined calcium and acid-base disturbances did not vary. There was no significant difference in IE. However, more patients developed AEs such as fatigue, muscle spasms or pain using CiDi (StDi: 41 versus CiDi: 55 patients, P = 0.02), particularly in the first 2 weeks of exposure. Dialysis efficacy was comparable with both dialysates.
It can be confirmed that CiDi is not associated with the development of severe calcium and acid-base disorders, even when dialysis modalities with higher citrate loads are used. However, a refinement of the CiDi composition to minimize AEs is necessary.