Dialysat au citrate : effets cliniques et variations des paramètres phosphocalciques, étude observationnelle

Abstract : Background: the citrate dialysate (CD) is increasingly used. Calcium balance and hyperparathyroidism control could be altered due to the lower concentration of ionized calcium in dialysis fluid between acetate (AD) and CD. Randomized studies are not always transposable in the real life. The aim of this prospective study is to assess clinical and biological parameters after switch from acetate to citrate dialysate in 4 self-dialysis units. Methods: 56 hemodialysis patients (63±14 years), treated in 4 self-dialysis units (one nephrologist visit and one biological evaluation per month) were switched from AD to CD. Calcium concentration was 1.5 mmol/L vs 1.75 mmol/L to ensure same calcium mass balance based on literature review. Usual monthly biological evaluations (including PTH) were performed in 4 different laboratories (close to the unit, far from the main dialysis in-center) during 6-month follow-up. Results: calcemia was not different at 6 months over citrate dialysate (2.21mmol/L versus 2.24mmol/L at M6, p=0.26). PTH was significantly lower at 6 months (462pg/mL versus 306 pg/mL, p=0.0003). 3rd generation PTH assay changed in two laboratories. Upper limit of normal range is different between the two kits. Patients KDIGO classification could be different. Using an electronic patient database, the physician is not always aware of this change. β2microglobuline decreases (30.76mg/L versus 27.01mg/L, p<0.001). Adverse events (muscles spasms, hypotension) seemed to be lower under citrate dialysate and no coagulation problem occurred. Conclusion: citrate dialysate with higher calcium concentration compare with acetate dialysate can decrease PTH blood level but the attention of physician could be drawn on PTH kit change.
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Master Thesis
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Delphine Hebmann. Dialysat au citrate : effets cliniques et variations des paramètres phosphocalciques, étude observationnelle. Médecine humaine et pathologie. 2017. ⟨dumas-01598082⟩

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