The Effects of Acetate-Free Citrate-Containing Dialysate on Calcium Metabolism and Fatigue in Patients on Maintenance Hemodialysis
American Journal of Clinical and Experimental Medicine
Volume 5, Issue 6, November 2017, Pages: 190-196
Received: Aug. 17, 2017;
Accepted: Sep. 8, 2017;
Published: Oct. 9, 2017
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Shinsuke Yamada, Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Asahi-Machi, Abeno-Ku, Osaka, Japan
Masaaki Inaba, Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Asahi-Machi, Abeno-Ku, Osaka, Japan
Shoji Tsuchiya, Mihama Narita Clinic, Iida-Cho, Narita, Chiba, Japan
Motoyuki Masai, Department of Nephrology, Mihama Hospital, Utase, Mihama-Ku, Chiba, Japan
Koichi Murakami, Mihama Narita Clinic, Iida-Cho, Narita, Chiba, Japan
Junji Uchino, Department of Nephrology, Mihama Hospital, Utase, Mihama-Ku, Chiba, Japan
Masanori Emoto, Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Asahi-Machi, Abeno-Ku, Osaka, Japan
Toyohiko Yoshida, Department of Nephrology, Mihama Hospital, Utase, Mihama-Ku, Chiba, Japan
Although the significance of acetate-free citrate with 3.0 mEq/L Ca-containing-dialysate (A(−)D) has been reported, its effective Ca level and the overtreatment needed to correct metabolic acidosis on the basis of serum whole parathyroid hormone (wPTH) and arterial pH have not been evaluated in detail. Furthermore, recent reports have suggested the beneficial effect of citrate on fatigue, which is a significant risk for cardiovascular disease. Thirty-two hemodialysis patients receiving acetate with 2.75 mEq/L Ca-containing dialysate (A(+)D) participated in the present A(+)D to A(–)D one-arm switch study over 4 weeks. Predialysis wPTH increased significantly from 85.1 ± 59.0 pg/mL during hemodialysis A(+)D to 106.8 ± 78.8 pg/mL (p = 0.0015) after 2 weeks of A(–)D treatment. Predialysis arterial pH and bicarbonate levels significantly increased from 7.335 ± 0.037 to 7.370 ± 0.035 (p < 0.0001) and from 19.6 ± 2.1 mEq/L to 21.3 ± 1.7 mEq/L (p = 0.0001), respectively, whereas post-dialysis arterial pH and bicarbonate levels significantly increased from 7.447 ± 0.022 to 7.473 ± 0.027 (p < 0.0001) and from 25.2 ± 1.0 mEq/L to 28.1 ± 1.0 mEq/L (p < 0.0001). When all patients were divided into two equal-sized groups by fatigue score, the improvement in the fatigue score was significantly greater in the high group (Δ1.8 ± 3.7) than in the low group (Δ–0.8 ± 2.3) (p = 0.0252). This study demonstrated that the effective Ca level might be significantly lower in A(−)D than in A(+)D and metabolic acidosis was improved more strongly in A(–)D relative to that in A(+)D because of the higher bicarbonate concentration in A(–)D. Furthermore, A(–)D had a beneficial effect on intradialytic hemodynamics and fatigue sensation.
The Effects of Acetate-Free Citrate-Containing Dialysate on Calcium Metabolism and Fatigue in Patients on Maintenance Hemodialysis, American Journal of Clinical and Experimental Medicine.
Vol. 5, No. 6,
2017, pp. 190-196.
Zucchelli P. Hemodialysis-induced symptomatic hypotension. A review of pathophysiological mechanisms. Int J Artif Organs 1987; 10: 139-144.
Kuragano T, Kida A, Furuta M, Yahiro M, Kitamura R, Otaki Y, Nonoguchi H, Matsumoto A, Nakanishi T. Effects of acetate-free citrate-containing dialysate on metabolic acidosis, anemia, and malnutrition pppin hemodialysis patients. Artif Organs 2012; 36: 282-290.
Kuragano T, Furuta M, Yashiro M, Kida A, Otaki Y, Hasuike Y, Matsumoto A, Nakanishi T. Acetate free citrate-containing dialysate increase intact-PTH and BAP levels in the patients with low intact-PTH. BMC Nephrology 2013; 14: 18.
Toussaint N, Cooney P, Kerr PG. Review of dialysate calcium concentration in hemodialysis. Hemodial Int 2006; 10: 326-337.
Yamano E, Sugimoto M, Hirayama A, Kume S, Yamato M, Jin G, Tajima S, Goda N, Iwai K, Fukuda S, Yamaguti K, Kuratsune H, Soga T, Watanabe Y, Kataoka Y. Index markers of chronic fatigue syndrome with dysfunction of TCA and urea cycles. Sci Rep 2016; 6: 34990.
Koyama H, Fukuda S, Shoji T, Inaba M, Tsujimoto Y, Tabata T, Okuno S, Yamakawa T, Okada S, Okamura M, Kuratsune H, Fujii H, Hirayama Y, Watanabe Y, Nishizawa Y. Fatigue is a predictor for cardiovascular outcomes in patients undergoing hemodialysis. Clin J Am Soc Nephrol 2010; 5: 659-666.
Yamasaki A, Yoda K, Koyama H, Yamada S, Tsujimoto Y, Okuno S, Okada S, Inaba M. Association of erythropoietin resistance with fatigue in hemodialysis patients: A cross-sectional study. Nephron 2016; 134: 95-102.
Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J 1973; 4: 643-646.
Ljungdahl N, Haarhaus M, Linder C, Magnusson P. Comparison of 3 third-generation assays for bio-intact parathyroid hormone. Clin Chem 2006; 52: 903-904.
Shimizu Y, Fukumoto S, Fujita T. Evaluation of a new automated chemiluminescence immunoassay for FGF23. J Bone Miner Metab 2012; 30: 217-221.
Fukuda S, Takashima S, Iwase M, Yamaguchi K, Kuratsune H, Watanabe Y. Development and validation of a new fatigue scale for fatigued subjects with and without chronic fatigue syndrome. In: Fatigue Science for Human Health, edited by Watanabe Y, Evengard B, Natelson BH, Jason LA, Kuratsune H, editors. New York, Springer, 2008, pp 89–102.
Moore C, Yee J, Malluche H, Rao DS, Monier-Faugere MC, Adams E, Daramola-Ogunwuyi O, Fehmi H, Bhat S, Osman-Malik Y. Relationship between bone histology and markers of bone and mineral metabolism in African-American hemodialysis patients. Clin J Am Soc Nephrol 2009; 4: 1484-1493.
London GM, Marchais SJ, Guérin AP, Boutouyrie P, Métivier F, de Vernejoul MC. Association of bone activity, calcium load, aortic stiffness, and calcifications in ESRD. J Am Soc Nephrol 2008; 19: 1827-1835.
Goodman WG, Ramirez JA, Belin TR, Chon Y, Gales B, Segre GV, Salusky IB. Development of adynamic bone in patients with secondary hyperparathyroidism after intermittent calcitriol therapy. Kidney Int 1994; 46: 1160-1166.
Malluche H, Mawad H, Monier-Faugere MC. The importance of bone health in end-stage renal disease: Out of the frying pan, into the fire? Nephrol Dial Transplant 2004; 19: i9-13.
Giotta N, Marino A. Calcimimetics, calcium set point and calcium balance. Nephrol Dial Transplant 2008; 23: 4083-4084.
Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, Andreucci VE, Fukagawa M, Frimat L, Mendelssohn DC, Port FK, Pisoni RL, Robinson BM. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol 2015; 10: 98-109.
Fujimori A, Yorifuji M, Sakai M, Oyama M, Nakao N, Tokuyama M, Fukagawa M. Low-calcium dialysate improves mineral metabolism in hemodialysis patients. Clin Nephrol 2007; 67: 20-24.
Yamamoto T, Shoji S, Yamakawa T, Wada A, Suzuki K, Iseki K, Tsubakihara Y. Predialysis and postdialysis ph and bicarbonate and risk of all-cause and cardiovascular mortality in long-term hemodialysis patients. Am J Kidney Dis 2015; 66: 469-478.
Zucchelli P. Hemodialysis‒induced symptomatic hypotension. A review of pathophysiological mechanisms. Int J Artif Organs 1987; 10: 139-144.
Sugino T, Aoyagi S, Shirai T, Kajimoto Y, Kajimoto O. Effects of citric acid and lcarnitine on physical fatigue. J Clin Biochem Nutr 2007; 41: 224-230.
Michael Schmitz, Olaf Loke, Bernhard Fach, Kalb K, Heering PJ, Meinke D, Rawer P, Galle J, Kozik-Jaromin J. Effects of citrate dialysate in chronic dialysis: a multicentre randomized crossover study. Nephrol Dial Transplant 2016; 31: 1327-1334.
Armstrong CW, McGregor NR, Lewis DP, Butt HL, Gooley PR. Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients. Metabolomics 2015; 11: 1626-1639.