Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study

Overview

Journal Int J Nephrol

Publisher Wiley

Specialty Nephrology

Date 2023 Oct 9

PMID 37809041

Authors

Yuli Shen

Christoph Schmaderer

Andreas Ossadnik

Arianne Hammitzsch

Javier Carbajo-Lozoya

Quirin Bachmann

Vera Bonell

Matthias Christoph Braunisch

Uwe Heemann

Dang Pham

Stephan Kemmner

Georg Lorenz

Affiliations

Soon will be listed here.

Abstract

Introduction: Due to chronic inflammation, maintenance hemodialysis (MHD) patients continue to show excess mortality. Acetate-free citrate-buffered A concentrates could be a way to improve the biocompatibility of the procedure, reduce chronic inflammation, and thus in the long term improve the prognosis of patients.

Methods: Using a pre-post design (3 months of acetate followed by 3 months of citrate-acidified A concentrates in standard bicarbonate-based dialysate hemodialysis, CiaHD) and linear mixed model analysis in 61 stable HD patients, we assessed the impact of CiaHD on counts and phenotypes of peripheral T cells and monocytes by flow cytometry.

Results: Switching to CiaHD left C-reactive protein (CRP) levels and leucocyte counts unaffected. However, CiaHD increased lymphocyte counts ex vivo. Furthermore, we found a decrease in total CD3+CD4+CD69+ ((10/L), mean ± SD: acetate, 0.04 ± 1.0 versus citrate, 0.02 ± 0.01; = 0.02) activated cells, while the number of CD28+ T cells remained stable. No differences were noted regarding T-cell exhaustion marker expression, CD14+CD16+ monocyte counts, and PMN-MDSCs.

Conclusion: Compared with acetate, CiaHD has a minor impact on lymphocyte counts and CD4+T-cell activation, which was independent of systemic CRP and ionized magnesium, calcium levels, and other dialysis prescription modalities.

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