Calcium Mass Balance and Dialytic Efficiency of a New cITRate-containing and Acetate-free Dialysis flUidS: CITRUS Study

NCT02848937 — Unknown, 62 participants, Azienda Ospedaliera, Ospedale Civile di Legnano

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RegistryNCT02848937, acronym CITRUS
StatusUnknown
Study typeObservational
Enrollment62 (Estimated)
SponsorAzienda Ospedaliera, Ospedale Civile di Legnano (Other); collaborators: AO Garbagnate-Bollate
ConditionsESRD
InterventionsBath with citrate, Bath with citrate and Ca_eq (Device)
Datesstart 2013-03-01, primary completion 2016-07-01, completion 2016-12-01 (estimated), first posted 2016-07-29, last updated 2016-07-29
Locations1 site in Italy

Related Papers Related Patents Related Grants Related Experts
All trials for ESRD All trials of Bath with citrate All trials of Bath with citrate and Ca_eq

-Summary

This study aimed to evaluate the effect on the calcium balance of a concentrate with 1 mM citrate and locate the equivalent concentration of calcium (Ca_eq) at a concentration of 3 mM acetate and traditional with 1.5 mM calcium in HD. The secondary objective is to evaluate the performance in the medium term of purifying the concentrate with 1 mM citrate and Ca_eq, compared to traditional concentrated with 3 mM acetate and 1.5 mM calcium in HD.

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+Detailed description

Primary Objective The primary objective of this study is to find the formulation of calcium (1.50, 1.65 and 1.75 mM) in the bath with 1 mM citrate which allows the equivalence of calcium balance (Ca_eq) in a sitting HD compared to traditional concentrated with 3 mM of calcium acetate and 1.5.

Secondary objectives

* Evaluate the purifying performance of small and medium-sized molecules in HD with concentrated with 1 mM citrate and Ca_eq compared to traditional concentrated with 3 mM calcium acetate and 1.5.
* Observe the effects on hemodynamic of the concentrate through the variation of the pre and post-dialysis blood pressure and intradialytic symptoms (cramps, hypotension, headache).
* Evaluate the variations of the parameters of mineral metabolism: Predialytic values of PTH, alkaline phosphatase treatments with concentrated Cit (1 mM citrate and Ca_eq) and concentrated with traditional Ac (3 mM calcium acetate and 1.5).

+Arms and interventions

ArmTypeInterventionsDescription
Bath with citrateDevice: Bath with citrateEach patient will participate in two phases of the study. The first phase has the aim to identify the concentration of calcium in the bath with citrate which allows the equivalence of mass balance (Ca_eq) compared to the concentrate with 3 mM acetate and 1.5 mM of calcium (4 weeks). Each week, the concentration of calcium in the bath with citrate is increased from 1.5-, to 1.65, to 1.75 mM. •Concentrate SelectBag One (with 3 mM acetic acid) and SelectBag Citrate (with 1 mM of citric acid). The potassium in the bath will be chosen on the basis of the needs of the patient (2 to 3.5 mM) and will be maintained in all concentrates.•All treatment parameters (Qb, time of treatment, weight loss and anticoagulant dose) should be overlapped at all stages of the study
Bath with citrate and Ca_eqDevice: Bath with citrate and Ca_eqEach patient will participate in two phases of the study. In the second phase will evaluate the effectiveness of the purification concentrate with 1 mM citrate and Ca_eq compared to the concentrate with 3 mM acetate and 1.5 mM calcium. For each of the sessions will be used the following materials: * Filter high permeability (Kuf> 20ml/mmHg); * Concentrate SelectBag One (with 3 mM acetic acid) and SelectBag Citrate (with 1 mM of citric acid). The potassium in the bath will be chosen on the basis of the needs of the patient (2 to 3.5 mM) and will be maintained in all concentrates. * All treatment parameters (Qb, time of treatment, weight loss and anticoagulant dose) should be overlapped at all stages of the study.
  • Bath with citrate (Device), also known as Select Bag Citrate: bath with citrate which allows the equivalence of mass balance (Ca_eq) compared to the concentrate with 3 mM acetate and 1.5 mM of calcium
  • Bath with citrate and Ca_eq (Device), also known as Select Bag Citrate: bath with citrate and Ca_eq of concentrate with 3 mM acetate and 1.5 mM of calcium

+Outcome measures

Primary outcomes

  • Plasma calcium level evaluation (mEq/l) [6 months]: Calcium balance from data of the calcium ion and total dialysate compartment. Complete blood count pre-and post-dialysis, total Proteins pre-and post-dialysis, will be collected from the patient's blood sitting in the middle of the week. Biochemical data from the dialysis fluid and spent dialysate sitting in the middle of the week:Calcium ion (EGA) and total in the dialysis fluid in the following times: 5, 120, end of dialysis; Calcium ion (EGA) and total effluent in the following times: 5, 120, end of dialysis

Secondary outcomes

  • Evaluate purifying performance of small and medium-sized molecules in HD (Kt/V) [6 months]: Evaluate the purifying performance of small and medium-sized molecules in HD (EKt/V) with concentrated with 1 mM citrate and Ca_eq compared to traditional concentrated with 3 mM calcium acetate and 1.5
  • Evaluation of variations of the parameters of mineral metabolism [6 months]: Evaluate the variations of the parameters of mineral metabolism: Predialytic values of PTH (mEq/l), alkaline phosphatase treatments (U/I) with concentrated Cit (1 mM citrate and Ca_eq) and concentrated with traditional Ac (3 mM calcium acetate and 1.5

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients clinically stable.

  * age> 18 years.
  * HD therapy for more than 3 months.
  * good vascular access native functionality that enables real blood flow of at least 250 ml / min.

Exclusion Criteria:

* Patients with the features listed below may not be enrolled in this survey:

  * Life expectancy <6 months.
  * residual diuresis> 500 ml / day.

+Locations (1)

FacilityCityCountryStatus
Carlo Maria GuastoniLegnano, MilanoItalyRecruiting

+Publications

  • Ahmad S, Callan R, Cole JJ, Blagg CR. Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis. 2000 Mar;35(3):493-9. doi: 10.1016/s0272-6386(00)70203-4. PMID 10692276
  • Bauer E, Derfler K, Joukhadar C, Druml W. Citrate kinetics in patients receiving long-term hemodialysis therapy. Am J Kidney Dis. 2005 Nov;46(5):903-7. doi: 10.1053/j.ajkd.2005.07.041. PMID 16253731
  • Kossmann RJ, Gonzales A, Callan R, Ahmad S. Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study. Clin J Am Soc Nephrol. 2009 Sep;4(9):1459-64. doi: 10.2215/CJN.02590409. Epub 2009 Aug 6. PMID 19661218
  • Bosticardo G, Malberti F, Basile C, Leardini L, Libutti P, Filiberti O, Schillaci E, Ravani P. Optimizing the dialysate calcium concentration in bicarbonate haemodialysis. Nephrol Dial Transplant. 2012 Jun;27(6):2489-96. doi: 10.1093/ndt/gfr733. Epub 2012 Feb 21. PMID 22357700

+Investigators