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The Scientific World Journal
Volume 2013, Article ID 703612, 7 pages
Clinical Study

Post-Dilution on Line Haemodiafiltration with Citrate Dialysate: First Clinical Experience in Chronic Dialysis Patients

1Nephrology and Dialysis Unit, Versilia Hospital, 55034 Lido Camaiore (Lucca), Italy
2Nephrology and Dialysis Unit, Parma Hospital, 43100 Parma, Italy
3Nephrology and Dialysis Unit, Lucca Hospital, 55100 Lucca, Italy
4Nephrology and Dialysis Unit, SM Annunziata Hospital, 50012 Florence, Italy

Received 4 September 2013; Accepted 28 October 2013

Academic Editors: F. Hinoshita and R. Sakai

Copyright © 2013 Vincenzo Panichi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD) replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF). Methods. Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions) of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate. Results. In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD) ionized calcium levels remained stable within the normal range. Conclusions. Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.