Application of different buffer bicarbonate dialysates in hemodialysis patients without anticoagulant heparin

Objective  To compare the efficacies of citrate bicarbonate dialysate versus acetate bicarbonate dialysate for hemodialysis without anticoagulant to provide rationales for selecting an optimal dialysate.

Methods  For this self-control study, 42 maintenance hemodialysis patients were recruited. Each subject underwent hemodialysis twice without anticoagulant. Citrate bicarbonate dialysate and acetate bicarbonate dialysate were used once each. Two groups were compared with regards to platelet, pH, HCO₃⁻, Ca²⁺, coagulation index, coagulation of cardiopulmonary bypass (CPB) pipeline/filter, treatment completion rate and adverse reactions before and after each dialysis.

Result  Both groups could well-tolerate the treatment and there were no adverse reactions of nausea, vomiting, hypotension, muscle spasm, hypocalcemia or hemorrhage. No significant inter-group differences existed in platelet, pH,HCO₃⁻, Ca^{2 +}, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT) or fibrinogen (FIB-C) pre-treatment (P>0.05). No significant differences existed in platelet, PH or APTT post-treatment (P>0.05). However, significant differences existed in HCO₃⁻, Ca^{2 +}, PT, INR, TT and FIB-C (P<0.05). The degree of coagulation grading of CPB pipeline/filter was lighter in citric acid group than that in acetic acid group. And completion rate of treatment was higher (85.7% vs 64.3%, P<0.05).

Conclusion  In clinical application of hemodialysis without anticoagulant, the safety of citrate bicarbonate dialysate is equivalent to that of acetate bicarbonate dialysate. Coagulation condition of CPB pipeline/filter and completion of dialysis treatment are better than those of acetate bicarbonate dialysate.