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Citrate supplementation of PD fluid: effects on net ultrafiltration and clearance of small solutes in single dwells

Journal article
Authors Magnus Braide
Börje Haraldsson
Ulf Persson
Published in Nephrol Dial Transplant
Volume 24
Issue 1
Pages 286-92
ISSN 1460-2385 (Electronic)
Publication year 2009
Published at Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 286-92
Language en
Links ndt.oxfordjournals.org/cgi/content/...
Keywords Aged, Anti-Inflammatory Agents, Non-Steroidal/administration & dosage, Citrates/*administration & dosage, Cross-Over Studies, Dialysis Solutions/*chemistry, Female, Heparin/administration & dosage, Humans, Kidney Failure, Chronic/physiopathology/therapy, Male, Middle Aged, Peritoneal Dialysis/*methods
Subject categories Physiology, Cell and Molecular Biology, Kidney diseases

Abstract

BACKGROUND: Inflammatory reactions affect the general performance as well as the technique survival of peritoneal dialysis (PD). Anti-inflammatory additives like heparin and sodium citrate have shown favourable results in these respects. The present study is the first to evaluate citrate-supplemented PD fluids (PDFs) in humans. METHODS: Crossover design was used to evaluate sodium citrate and heparin-supplemented Gambrosol Trio (2.5% glucose) in 28 stable outpatients from the PD unit. Comparisons were made between single dwells of each fluid. Citrate supplementation at 5 mM/L was compared with standard PDF, and citrate supplementation at 10 mM/L was compared with low-molecular-weight heparin (4500 units of tinzaparin) supplementation and standard PDF. The initial osmolarity of the fluids was equalized by adding sodium chloride. RESULTS: Citrate supplementation at 5 mM/L significantly increased net ultrafiltration, measured as drained volume gain, by 126 mL. Creatinine and phosphate clearance, but not glucose clearance, was significantly improved by supplementation with citrate or heparin. Heparin supplementation created an insignificant trend towards an increased ultrafiltration (P = 0.08). No negative side effects were reported for any of the treatments; however, citrate supplementation led to a small calcium loss by the drained PD fluid (0.4 mmol) and a transient fall in the plasma concentration (0.04 mM/L) of free calcium ions at 5 mM/L citrate. Effects on plasma bicarbonate concentration were insignificant. CONCLUSIONS: Citrate supplementation of PD fluid improved ultrafiltration and clearance of small solutes with only minor effects on calcium turnover. The mechanism is unknown and, according to the results, not related to complement inhibition.

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