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NDT Advance Access originally published online on February 7, 2006
Nephrology Dialysis Transplantation 2006 21(6):1648-1651; doi:10.1093/ndt/gfk093
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Original Articles: Dialysis and Transplantation

On-line haemodiafiltration with and without acetate

Francesco Pizzarelli, Tiziano Cerrai, Pietro Dattolo and Giuseppe Ferro

Nephrology and Dialysis Unit, SM Annunziata Hospital, Florence, Italy

Correspondence and offprint requests to: Dr Francesco Pizzarelli, Head of Nephrology Unit, SM Annunziata Hospital, Via dell’ Antella 58, 50011 Antella-Firenze, Italy. Email: fpizzarelli{at}yahoo.com

Background. In patients on on-line convective treatments, given the considerable quantity of dialysis fluid re-infused, the small amount of acetate present in bicarbonate dialysis fluid as a pH stabilizing factor may allow a significant transfer of that anion to the patient, possibly inducing cytokine activation.

Methods. To verify this hypothesis, we performed on-line haemodiafiltration (OL-HDF) with (3 mmol/l) and without acetate in dialysis fluid in a cross-over randomized order on 12 prevalent patients.

Results. In comparison with the pre-treatment values, plasma acetate levels were unchanged during and after acetate-free OL-HDF, while they were 5–6 times higher in the course of OL-HDF containing acetate in dialysis fluid; plasma acetate levels returned to basal values 2 h after the end of the procedure. The total increase of bases in the patient attributable to acetate was 36%. Plasma bicarbonate values at the end of treatment were significantly lower in treatments without acetate, as compared to those with acetate. Interleukin-6 plasma levels were super-imposable at the beginning and in the course of the two methods compared, but there was a tendency towards a greater increase at an interval of 2 h following OL-HDF with acetate.

Conclusions. Our preliminary results confirm the assumption that body gain of acetate is particularly high in convective treatments, while acetate-free OL-HDF slows down acetate burden. Clinical advantages due to these effects should be evaluated in properly designed prospective studies.

Keywords: acetate; acetate-free dialysate; cytokines; inflammation; on-line haemodiafiltration


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