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- Title
Acetate-containing bicarbonate dialysate increases all-cause mortality more than acetate-free bicarbonate dialysate containing citrate in hemodialysis patients.
- Authors
Okada, Kazuyoshi; Tashiro, Manabu; Michiwaki, Hiroyuki; Tanaka, Yusaku; Yamashita, Syo; Inoue, Tomoko; Shima, Hisato; Minakuchi, Jun
- Abstract
Background: No studies have compared mortality between acetate-containing bicarbonate dialysate (ABD) and acetate-free bicarbonate dialysate containing citrate (AFD) in hemodialysis (HD) or online hemodiafiltration (OHDF). We therefore compared mortality between ABD and AFD in each modality. Methods: This retrospective observational study included 738 patients who were receiving super high-flux (SHF) or SHF albumin-leaking HD (n = 310: ABD 235 and AFD 75) or OHDF (n = 428: ABD 321 and AFD 107) at our institution between 1 April and 1 July 2017. Three-year all-cause mortality was compared between ABD and AFD in the HD or OHDF groups using a propensity score matching model. Kaplan–Meier survival curves were compared using the log-rank test, and then Cox regression analysis with adjustments was performed for some covariates that remained significant. Results: After propensity score matching, mortality on ABD was not significantly different from that on AFD in the HD group [n = 75; hazard ratio (HR) 2.271, 95% confidence interval (CI) 0.863–5.981, P = 0.087] or in the OHDF group (n = 107; HR 1.944, 95% CI 0.585–6.458, P = 0.269) without adjustments. However, with adjustments using some covariates, mortality was significantly higher on ABD than on AFD (adjusted HR 4.501, 95% CI 1.434–14.125, P = 0.010) in the HD group, but not in the OHDF group. Conclusions: These findings suggest that ABD worsens mortality more than AFD in patients on SHF and SHF albumin-leaking HD. Trial registration: UMIN Clinical Trials Registry, UMIN000053090. Prospectively registered 13 December 2023, https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000060581.
- Subjects
MORTALITY risk factors; HEMODIAFILTRATION; RISK assessment; ACETIC acid; SCIENTIFIC observation; BICARBONATE ions; HEMODIALYSIS; RETROSPECTIVE studies; DESCRIPTIVE statistics; KAPLAN-Meier estimator; LOG-rank test; STATISTICS; DRUGS; CITRATES; COMPARATIVE studies; CONFIDENCE intervals; DATA analysis software; SERUM albumin
- Publication
Renal Replacement Therapy, 2024, Vol 10, Issue 1, p1
- ISSN
2059-1381
- Publication type
Article
- DOI
10.1186/s41100-024-00553-z