HDCN Abstract:  Am Soc Nephrol Ann Mtg -- Toronto  

Ahmad S, Callan R, Cole JJ, Blagg CR

Effect of citrate-containing dialysate on dialyzer reuse

Am Soc Nephrol Ann Mtg -- Toronto
J Am Soc Nephrol (Sep) 11:172A 2000

Dialyzer performance is mainly dependent on surface area and membrane permeability, both of which can be decreased by "clotting" of fibers and pores. One indication of this is fiber bundle volume loss.

Recently a new commercially available dialysate (DRYalysate, Advanced Renal Technologies, Kirkland, WA) has been described (Ahmad et al, Am J Kid Dis, 35:493,2000). Citrate in the dialysate was suggested to reduce fiber clotting accounting for better dialysis dose associated with the DRYalysate.

In the present study we compared dialyzer reuse in 29 patients over 8 to 24 months (average 12.6 months) for 4,228 dialysis sessions using either regular dialysate or DRYalysate. DRYalysate contained 2.4 mEq/l of citrate and 0.3 mEq/l of acetate; in comparison the regular (bicarbonate) dialysate contained 4.0 mEq/L of acetate. All other constituents in both dialysates were identical.

Both high flux (F-80 and F-60) and traditional dialyzers (F-8, T-175, CA-HP110 and MCA180) were employed. At the beginning of each regular or citrate dialysate test period, patients were started on a new dialyzer. Reuse involved flushing with water, cleaning with 2% sodium hypochlorite solution, and sterilization with 2% formaldehyde and incubation at 40 degrees C. Dialyzers were discarded if fiber bundle volume loss was >15% (in one dialysis unit) and >20% (in two dialysis units). The reuse method and criteria remained unchanged at each unit throughout the comparison periods. The average number of uses on regular dialysate was 10.9 +/- 1.2 (mean +/- SEM.).

On citrate dialysate, the number of dialyzer uses significantly increased to 18.5 +/- 2.1 (p<0.0001)uses. These results indicate that citrate dialysate reduces clotting of fibers, and enables a significantly higher number of dialyzer re-uses.

Copyright 2000, American Society of Nephrology. Reproduced with permission.