https://orcid.org/0000-0002-4374-251X
![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Background
Citrate dialysate (CD) has been successfully used in conventional hemodialysis and continuous renal replacement therapy; however, no study has compared pre- and post-dilution online hemodiafiltration (oL-HDF). Therefore, we aimed to investigate the efficacy of citrate anticoagulation for oL-HDF and the metabolic changes and quality of life of patients on hemodialysis treated using both modes
Method
Eight dialysis patients were treated with CD containing 0.8 mmol of citric acid for 4 weeks in each phase. Visual clotting scores were investigated as the primary endpoints. Adequacy of dialysis, laboratory parameters, and quality of life were measured as secondary objectives.
Results
The mean clotting scores in the pre-dilution mode were significantly lower than those in the post-dilution mode and in all phases except the heparin-free phase (p < 0.001 in the baseline phase, p = 0.001 in phase 1, and p = 0.023 in phase 2). The values of Kt/V in both modalities were comparable except during the baseline phase, in which the values of pre-dilution were significantly greater than post-dilution (2.36 ± 0.52/week vs. 1.87 ± 0.33/week;95% CI −0.81 to −0.19, p = 0.002). The patient’s quality of life regarding their physical activity level was significantly higher in the post-dilution mode than in the pre-dilution mode at baseline and in phase 1 (p = 0.014 and 0.004 at baseline and in phase 1, respectively). Metabolic changes did not differ between the two modes.
Conclusion
Citrate dialysate decreased or prevented anticoagulation in both pre- and post-dilution modes of oL-HDF without significant side effects and had comparable adequacy of dialysis.
Acknowledgement
The authors thank all staff and investigators involved in this study and Ms. Worachanee Imjaijit for her statistical analyses.This manuscript has been published as a preprint version in Research Square https://doi.org/10.21203/rs.3.rs-2536555/v1. The authors thank Editage (www.editage.com) for English language editing.
Authors’ contributions
TT supervised the project, interpreted the data, contributed to the writing of the manuscript, had full access to the data in the study, and contributed to the study design. PN contributed to data collection and conceived and designed the study. KM and MH conducted the study and collected the data. All authors have approved the final version of the manuscript for submission.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
Data supporting the findings of this study are available from the corresponding author. Data supporting the findings of this study are openly available in ‘figshare’ at http://10.6084/m9.figshare.21971570.