Abstract:

Objective: To compare the antihypertensive effect of citrate-based dialysate versus regular dialysate in bicarbonate hemodialysis.  Methodology: In a crossover randomized design, twenty dialysis patients with hypertension during dialysis underwent two cycles of twelve successive hemodialysis sessions each with a regular bicarbonate and citrate bicarbonate dialysate. At the last three sessions of each cycle, hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate) were measured every hour during dialysis. At the twelfth session of each cycle, Ca level (iCa, Serum total calcium), acid-base status (PH, HCo3^-) and dialysis efficient were assessed using standard biochemical marker. Result: (1)The patients receiving the citrate dialysate had significantly lower SBP, post-dialysis DBP and incidence of intradialysis hypertension, MAP was also lower than receiving regular bicarbonate dialysate. (2)When patients were treated with citrate dialysis, post-dialysis iCa level was significantly lower than pre-dialysis, but the total calcium concentration was not decreased. The patients receiving the regular dialysate had significantly higher post-dialysis iCa level and total calcium concentration. (3)The use of citrate was associated with an increased Kt/V, but there were no statistical differences. No patients developed severe hypotension, hypocalcemia, seizures and other side effect.  Conclusion：The positive impact on dialysis efficiency, BP and the safety,together indicated that citrate dialysate can significantly contribute to the imporvement hamodialysis in selected patients.